Question Of The Day: The Neonate

Q. The neonate of a client with type 1 diabetes is at high risk for hypoglycemia. An initial sign the nurse should recognize as indicating hypoglycemia in a neonate is:

A. peripheral acrocyanosis.
B. bradycardia.
C. lethargy.
D. jaundice.



Correct Answer: C

Reason: Lethargy in the neonate may be seen with hypoglycemia because of a lack of glucose in the nerve cells. Peripheral acrocyanosis is normal in the neonate because of immature capillary function. Tachycardia — not bradycardia — is seen with hypoglycemia. Jaundice isn't a sign of hypoglycemia.

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6 Reasons Why 2020 Is the Year of the Nurse 

Early in 2019, the World Health Organization (WHO) announced that 2020 would be the Year of the Nurse. WHO is planning lots of programming and reporting around the year to celebrate nurses and support the profession.

Here are six reasons why 2020 is the perfect time for the Year of the Nurse:

1. It’s the 200th anniversary of Florence Nightingale.

Florence Nightingale was born on May 12, 1820, making 2020 the 200th year anniversary of her birth. The “Lady with the Lamp” became the founder of modern nursing and the first woman to receive the Order of Merit. During the Crimean War, Nightingale was put in charge of nursing British and allied soldiers in Turkey. Her time in the wards, especially her night rounds, earned her the nickname “Lady with the Lamp” and helped her begin to formalize nursing education.

She went on to found the first scientifically based nursing school—the Nightingale School of Nursing at St. Thomas’ Hospital in London—in 1860. She also helped institute training for midwives and nurses working in workhouse infirmaries. Nightingale continues to inspire nurses all over the world with her legacy of dedication and innovation. While International Nurses Day commemorates her birthday every year on May 12, the 2020 celebrations will take place year-round and further champion nurses’ work.

2. It’s the release of the first State of the World’s Nursing Report.

In conjunction with the Year of the Nurse, WHO will be releasing its first-ever State of the World’s Nursing Report prior to the 73rd World Health Assembly in May 2020. According to WHO, “The report will describe the nursing workforce in the WHO Member States, providing an assessment of ‘fitness for purpose’ relative to GPW13 targets.” GPW13 refers to the Thirteenth General Programme of Work 2019−2023, which lays out WHO’s leadership priorities in five-year blocks. Some of WHO’s 2023 goals include reducing the global maternal mortality ratio by 30 percent and reducing malaria case incidences by 50 percent. WHO will also be a partner on the State of the World’s Midwifery 2020 Report, which will be launched around the same time as the State of the World’s Nursing Report.

3. It’s the culmination of the Nursing Now campaign.

The three-year Nursing Now global campaign launched in 2018 and will wrap up at the end of 2020. Nursing Now is a collaboration between the World Health Organization and the International Council of Nurses and is championed by Kate Middleton, Duchess of Cambridge.

Nursing Now focuses on five core areas: ensuring that nurses and midwives have a more prominent voice in health policy-making; encouraging greater investment in the nursing workforce; recruiting more nurses into leadership positions; conducting research that helps determine where nurses can have the greatest impact, and sharing of best nursing practices. Nurses can support Nursing Now by signing its support pledge, sharing about the campaign on social media, hosting events, sharing their experiences with other nurses and organizing to advocate for the nursing profession. You can also start or join a Nursing Now group in your local or regional area. There are currently groups in more than 100 countries worldwide.

4. Nurses make up a majority of the worldwide healthcare force.

While doctors get much of the attention, especially in Western nations, nurses and midwives make up more than 50 percent of the health workforce in many countries. Nurses armed with clinical supplies are usually the front line of care and, in some cases, maybe the only provider in the area, especially in developing countries. They make a difference not just in individual patients’ lives but also in the community as a whole. Due to their sheer numbers and the locations where they often work, nurses are vital players in improving public health outcomes around the world.

5. Nurses are a huge part of the healthcare worker shortfall.

Due to the major role they play in the worldwide healthcare workforce, nurses and midwives also make up a significant part of the nursing shortage–more than 50 percent of the shortfall in the global health workforce to 2030.

Looking at just the U.S., the Bureau of Labor Statistics (BLS) predicts that employment of registered nurses is projected to grow 12 percent from 2018 to 2028, much faster than the average for all occupations. BLS also predicts that the U.S. will need an additional 200,000+ nurses per year from now until 2026, adding up to more than one million additional nurses. And that’s just one country that already had a healthcare infrastructure that’s significantly more developed than some others.

6. Supporting nurses boosts economic growth and gender equality.

As part of Nursing Now and its other efforts to support nurses, WHO often speaks of the “Triple Impact” that comes from giving nurses what they need: better health, stronger economies, and greater gender equality. While the first outcome is more obvious, the succeeding ones are equally important. While men can and do become nurses, worldwide the vast majority of nurses are women. Becoming a nurse opens up opportunities for women, giving them the chance to receive a formal education, enroll in training programs, secure a license and finally get a job and its accompanying income. This improves overall economic growth and also increases gender equality in the workforce.

Nurses should already be proud of themselves when they don their scrubs for a shift, but in 2020, they’ll do so with the extra confidence of knowing that it’s the Year of the Nurse and that organizations all over the world are supporting their profession.

Source: nurseslabs.com

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Question Of The Day: Postpartum Period

Q. The nurse is assessing a client at her postpartum checkup 6 weeks after a vaginal delivery. The mother is bottle feeding her baby. Which client finding indicates a problem at this time?

A. Firm fundus at the symphysis.
B. White, thick vaginal discharge.
C. Striae that are silver in color.
D. Soft breasts without milk.


Correct Answer: A

Reason: By 4 to 6 weeks postpartum, the fundus should be deep in the pelvis and the size of a nonpregnant uterus. Subinvolution, caused by infection or retained placental fragments, is a problem associated with a uterus that is larger than expected at this time. Normal expectations include a white, thick vaginal discharge, striae that are beginning to fade to silver, and breasts that are soft without evidence of milk production (in a bottle-feeding mother).

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Question Of The Day: Intrapartum Period

Q. A client with Rh isoimmunization gives birth to a neonate with an enlarged heart and severe, generalized edema. The neonate is immediately transferred to the neonatal intensive care unit. Which nursing diagnosis is most appropriate for the client?

A. Ineffective denial related to a socially unacceptable infection
B. Impaired parenting related to the neonate's transfer to the intensive care unit
C. Deficient fluid volume related to severe edema
D. Fear related to removal and loss of the neonate by statute

Correct Answer: B

Reason: Because the neonate is severely ill and needs to be placed in the neonatal intensive care unit, the client may have a nursing diagnosis of Impaired parenting related to the neonate's transfer to the neonatal intensive care unit. (Another pertinent nursing diagnosis may be Compromised family coping related to lack of opportunity for bonding.) Rh isoimmunization isn't a socially unacceptable infection. This condition causes an excess fluid volume (not deficient) related to cardiac problems. Rh isoimmunization doesn't lead to loss of the neonate by statute.

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Question Of The Day: Antepartum Period

Q. A client has an episiotomy to widen her birth canal. Birth extends the incision into the anal sphincter. This complication is called:

A. a first-degree laceration.
B. a second-degree laceration.
C. a third-degree laceration.
D. a fourth-degree laceration.



Correct Answer: C

Reason: Birth may extend an episiotomy incision to the anal sphincter (a third-degree laceration) or the anal canal (a fourth-degree laceration). A first-degree laceration involves the fourchette, perineal skin, and vaginal mucous membranes. A second-degree laceration extends to the fasciae and muscle of the perineal body.

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Question Of The Day: Psychotic Disorders

Q. A client has refused to take a shower since being admitted 4 days earlier. He tells a nurse, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath

Correct Answer: D

Reason: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality by dismantling the shower head wouldn't be effective at this time. Explaining that other clients are complaining about his body odor or asking a security officer to assist in giving the client a shower would violate the client's rights by shaming or embarrassing him.

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The Ultimate List of Masters Degrees in Nursing

Are you considering getting your Master’s Degree in Nursing? A Master of Science in Nursing (MSN) degree can open the doorway to more opportunities for you as a nurse, from leadership positions to advanced clinical roles.

All types of MSN programs prepare a Registered Nurse to better serve different types of patient populations from a holistic perspective — graduate-level nursing courses will cover topics such as ethics, public health, leadership, healthcare practice, and clinical skills. As the American Association of Colleges of Nursing explains, a Master’s degree in nursing also prepares nurses on how to conduct research, consult, and implement evidence-based care and solutions.

One of the major benefits of an MSN degree is that not only does it offer more advancement opportunity and earning potential (MSN-prepared nurses earn an average of $93,000 per year), but it also allows you to specialize in a role and/or patient population that interests you the most. For instance, you can choose to specialize in a clinical specialty track as a Nurse Practitioner or choose a more administrative role, such as a nurse educator or consultant. Want to learn more about what types of MSN degrees are available? Here is a list of some of the many different specializations in Master Degrees in Nursing that you can pursue.

Master of Science in Nursing Degree

The following MSN tracks are commonly offered at many different schools across the nation, although there may be specialty course programs available at select schools as well:

◉ Public Health. With this degree, a nurse may pursue a track that is focused on broad public health goals, such as healthcare policy, population or community health. In this role, a nurse may complete population studies, perform research, analyze outcomes, and provide education and advocacy for public health goals. They may work at the state or local level on infectious diseases, disease prevention, and health promotion.

◉ Nurse Educator. As a nurse educator, you will be responsible for educating the next generation of nurses, both at the clinical and classroom levels. Nurse educators can conduct research, present at conferences, consult, and publish academic pieces to continually keep up-to-date on healthcare developments in the nursing profession. Nurse educators can work in a variety of settings and may have some flexibility to their schedules as well. If you are interested in becoming a nurse educator at the collegiate level, you should be prepared to continue to earn your doctorate degree as well.

◉ Nursing Informatics. In this role, nurses work in an intersection between technology and nursing. An informatics specialist could do things like consult on new technology systems, analyze and build data systems to reach healthcare goals or write computer programs.

◉ Nurse Administrator or Executive. This track—also known as Nurse Leadership—prepares a nurse to manage a team of other nurses and/or healthcare members. An MSN Nurse Administrator may serve as a unit manager, for instance, or in even more expanded leadership roles. Additional advanced certification for Nurse Administrators and Executives are available as well.

◉ Nurse Researcher. Are you fascinated by studies? A Nurse Researcher role might be right for you—in this track, nurses learn to perform, assess, analyze, and provide recommendations based on research.

Advanced Practice MSN degrees prepare a Registered Nurse for an advanced clinical role. In addition to earning an MSN degree, a nurse must pass a certifying exam in their chosen specialty field. Nurses who earn a Certified Master’s Degree will use the credential “C” with their title, i.e. a Certified Family Nurse Practitioner will be an FNP-C and a Certified Nurse Midwife will be a CNM. These degrees generally take 2-3 years to complete and include clinical hours as well as classroom coursework.

◉ Clinical Nurse Leader (CNL). As it sounds, in this role, nurses deliver and supervise bedside care and work with other team members to assess and improve clinical care. After earning your MSN, it’s recommended that nurses also become certified through the Commission on Nurse Certification as a CNL.

◉ Clinical Nurse Specialist (CNS). In this role, a nurse will serve as a clinical expert in one specialty field, such as geriatrics or acute care. A CNS can provide care and act in more of a consulting role for advanced practice.

◉ Certified Registered Nurse Anesthetist (CRNA). One of the highest-paid APRN roles, Certified Registered Nurse Anesthetists earns an average of $174,790, according to the Bureau of Labor and Statistics (BLS). CRNAs assess patients before administering anesthesia, monitor and adjust medication flow during the time the patient is under anesthesia, and provide post-anesthesia recovery. CRNAs can work in a variety of settings, from the hospital to surgical clinics and may work in a medical or oral surgeon field.

◉ Certified Nurse Midwife (CNM). CNMs are practitioners who provide complete pre and post-natal care, along with labor and delivery services and women’s health care. The average salary for a CNM is $106,910, according to the BLS. CNMs can work in an office setting, at a hospital or birth center, or in private practices.

◉ Nurse Practitioner. Nurse Practitioners work to provide advanced care to different patient populations; they can independently assess, diagnosis, treat, and prescribe medication. The BLS notes that the average salary for NPs is $110,030 annually. As an NP, you can choose from a variety of different specialties in your practice.

Much like a doctor can specialize in virtually any type of medical care, an NP can choose a specialty track with the corresponding certification to become an expert in his or her field. Some courses will allow you to specialize in your chosen field through your degree program, while others will have you become a general practitioner, and then take an additional certification course to specialize. The American Association of Nurse Practitioners lists the following different types of tracks available to NPs:

◉ Emergency NP

◉ Family NP

◉ Adult-Gerontology Primary Care NP

◉ Adult-Gerontology Acute Care NP

◉ Adult NP

◉ Acute Care NP

◉ Pediatric Primary Care NP

◉ Neonatal NP

◉ Pediatric Acute Care NP

◉ Women’s Health NP

◉ Psychiatric Mental Health-Family NP

◉ Psychiatric Mental Health NP

◉ Gerontology NP

◉ Orthopedic NP

Dual Master’s Degrees

You can also choose to pursue a dual degree to earn both your MSN and a concentration in another specialty. For example, according to the AACN 120 dual MSN degrees are available in the following specialties nationwide:

◉ MSN/MBA — to combine nursing with business

◉ MSN/MPH — a nursing degree with a public health degree (MSN/MPH)

◉ MSN/MHA — nursing and health administration

◉ MSN/MPA — nursing and public administration

Source: nurse.org

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A nurse is instructing a client with bipolar disorder on proper use of lithium carbonate (Eskalith), the drug's adverse effects, and symptoms of lithium toxicity. Which client statement indicates that additional teaching is required?

A. "I can still eat my favorite salty foods."
B. "When my moods fluctuate, I'll increase my dose of lithium."
C. "A good blood level of the drug means the drug concentration has stabilized."
D. "Eating too much watermelon will affect my lithium level."

Correct Answer: A

Reason: A client who states that he'll increase his dose of lithium if his mood fluctuates requires additional teaching because increasing the dose of lithium without evaluating the client's laboratory values can cause serious health problems, such as lithium toxicity, overdose, and renal failure. Clients taking lithium don't need to limit their sodium intake. A low-sodium diet causes lithium retention. A therapeutic lithium blood level indicates that the drug concentration has stabilized. The client demonstrates effective teaching by stating his lithium levels will be affected by foods that have a diuretic effect, such as watermelon, cantaloupe, grapefruit juice, and cranberry juice.

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Question Of The Day: School-age Child

Q. The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to:

A. Keep their home warmer than usual.

B. Encourage plenty of outdoor activities.

C. Promote interactions with one friend instead of groups.

D. Limit bathing to prevent skin irritation.

Correct Answer: C

Reason: Children with hyperthyroidism experience emotional labiality that may strain interpersonal relationships. Focusing on one friend is easier than adapting to group dynamics until the child's condition improves. Because of their high metabolic rate, children with hyperthyroidism complain of being too warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is common and bathing should be encouraged.

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Question Of The Day: Toddler

Q. A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottiditis. Which clinical manifestations should the nurse expect to assess?

A. Severe sore throat, drooling, and inspiratory stridor
B. Low-grade fever, stridor, and a barking cough
C. Pulmonary congestion, a productive cough, and a fever
D. Sore throat, a fever, and general malaise

Correct Answer: A

Reason: A child with acute epiglottiditis appears acutely ill and clinical manifestations may include drooling (because of difficulty swallowing), severe sore throat, hoarseness, a high temperature, and severe inspiratory stridor. A low-grade fever, stridor, and barking cough that worsens at night are suggestive of croup. Pulmonary congestion, productive cough, and fever along with nasal flaring, retractions, chest pain, dyspnea, decreased breath sounds, and crackles indicate pneumococcal pneumonia. A sore throat, fever, and general malaise point to viral pharyngitis.

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Question Of The Day: Infant

Q. A 10-month-old child has cold symptoms. The mother asks how she can clear the infant's nose. Which of the following would be the nurse's best recommendation?

A. Use a cool air vaporizer with plain water.
B. Use saline nose drops and then a bulb syringe.
C. Blow into the child's mouth to clear the infant's nose.
D. Administer a nonprescription vasoconstrictive nose spray.

Correct Answer: B

Reason: Although a cool air vaporizer may be recommended to humidify the environment, using saline nose drops and then a bulb syringe before meals and at nap and bed times will allow the child to breathe more easily. Saline helps to loosen secretions and keep the mucous membranes moist. The bulb syringe then gently aids in removing the loosened secretions. Blowing into the child's mouth to clear the nose introduces more organisms to the child. A nonprescription vasoconstrictive nasal spray is not recommended for infants because if the spray is used for longer than 3 days a rebound effect with increased inflammation occurs.

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Nurses Ranked Most Honest Profession 18 Years in a Row

In an impressive 18 year running streak, Americans have rated nurses as the #1 most ethical and honest profession, according to the most recent Gallup poll. 

The 2019 poll revealed that 85% of Americans rated nurses’ honesty and ethical standards as “high” or “very high,” coming in even higher than last year’s numbers. The honor is an impressive one, as the poll included other medical professionals, including physicians, dentists, and pharmacists. Nursing holds a high margin as the most honest and ethical, with the next most honest profession, engineering, ranking at 66%. 

Healthcare Dominates

Medical professionals, in general, are viewed as the most ethical and honest of all professions, as opposed to the professions Americans see as the least ethical and honest, such as Congress members (ranked by 9%) and car salespeople (9% ranked them as honest and ethical). 2019 marked a year of a lot of change in Americans’ perceptions of even professions that have historically widely been regarded as honest and ethical--clergy members, for instance, have continued to decline in the public’s view of who is the most ethical and honest--so the fact that nurses have continued to hold strong is a testament to the profession as a whole. 

As in the years past, the survey was conducted through telephone interviews that included both cellphone and landline respondents in a random sample of 1,025 adults in the U.S. 

2020 Named 'Year of the Nurse' 

Nursing’s news has been celebrated by The American Nurses Association (ANA) as the organization ushers in 2020 as the “Year of the Nurse,” designated by the World Health Organization (WHO) in honor of the 200th birth anniversary of Florence Nightingale. ANA is celebrating Year of the Nurse with special promotions, contests, and is encouraging nurses to share their own stories with the hashtag #YON2020 and #YearoftheNurse. 

“I am extremely proud that nurses everywhere have been bestowed this wonderful accolade by the people whose lives they touch every day. The fact that nurses have been consistently voted the most honest and ethical professionals is a testament to the public’s trust. We’ll work hard to keep their good faith throughout 2020 and beyond. I couldn’t think of a better way to enter into the “Year of the Nurse,” says ANA President Ernest Grant, Ph.D., RN, FAAN.

Grant added that the news from the Gallup poll not only is especially fitting in the Year of the Nurse but that the long-standing rank is an opportunity to shine a light on the noble profession of nursing. 

“This milestone celebration offers a platform to raise the visibility of nurses and increase the capacity of the nursing workforce,” he noted. “Nurses occupy many roles in our society and are on the front lines when it comes to immunizations, natural disaster preparedness, shaping health policy, and advocacy. For this reason, nurses are critical in improving the landscape of health and health care because an effective health care system is one that values all nurses.”

Thank you, Nurses! 

Here’s to 18 years in a row and the Year of the Nurse--which, in our opinion, should definitely be every year. Nurse.org applauds all of the nurses who continue to fight to change the lives of their patients and their families, the nursing students who are entering a profession that continues to advocate, and those who rated nurses as the most trusted and ethical profession again.

Source: nurse.org

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Question Of The Day: The Nursing Process

Q. A nurse is documenting a variance that has occurred during the shift, and this report will be used for quality improvement to identify high-risk patterns and potentially initiate in-service programs. This is an example of which type of report?

A. Incident report.
B. Nurse's shift report.
C. Transfer report.
D. Telemedicine report.

Correct Answer: A

Reason: An incident report, also termed a variance report or occurrence report, is a tool healthcare agencies use to document anything out of the ordinary that results in or has the potential to result in harm to a client, employee, or visitor. These reports are used for quality improvement and not for disciplinary action. They are a means of identifying risks and high-risk patterns and initiating in-service programs to prevent future problems. A nurse's shift report is given by a primary nurse to the nurse replacing him or her or by the charge nurse to the nurse who assumes responsibility for continuing client care. A transfer report is a summary of a client's condition and care when transferring clients from one unit or institution to another. A telemedicine report can link healthcare professionals immediately and enable nurses to receive and give critical information about clients in a timely fashion.

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

Q. To prevent development of peripheral neuropathies associated with isoniazid administration, the nurse should teach the client to:

A. Avoid excessive sun exposure.
B. Follow a low-cholesterol diet.
C. Obtain extra rest.
D. Supplement the diet with pyridoxine (vitamin B6).




Correct Answer: D

Reason: Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.

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Question Of The Day: Genitourinary Disorders

Q. When caring for a client after a closed renal biopsy, the nurse should?

A. Maintain the client on strict bed rest in a supine position for 6 hours.
B. Insert an indwelling catheter to monitor urine output.
C. Apply a sandbag to the biopsy site to prevent bleeding.
D. Administer I.V. opioid medications to promote comfort.

Correct Answer: A

Reason: After a renal biopsy, the client is maintained on strict bed rest in a supine position for at least 6 hours to prevent bleeding. If no bleeding occurs, the client typically resumes general activity after 24 hours. Urine output is monitored, but an indwelling catheter is not typically inserted. A pressure dressing is applied over the site, but a sandbag is not necessary. Opioids to control pain would not be anticipated; local discomfort at the biopsy site can be controlled with analgesics.

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Question Of The Day: Respiratory Disorders

Q. The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should:

A. Check respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression.
B. Check respirations in 30 minutes because the effects of morphine will have worn off by then.
C. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone.
D. Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

Correct Answer: C

Reason: The nurse should monitor the client's respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the client's respiratory rate will be necessary. The client's dosage of morphine will be decreased or a new drug will be ordered to prevent another instance of respiratory depression.

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Question Of The Day: Neurosensory Disorders

Q. The client with a hearing aid does not seem to be able to hear the nurse. The nurse should do which of the following?

A. Contact the client's audiologist.
B. Cleanse the hearing aid ear mold in normal saline.
C. Irrigate the ear canal.
D. Check the hearing aid's placement.



Correct Answer: D

Reason: Inadequate amplification can occur when a hearing aid is not placed properly. The certified audiologist is licensed to dispense hearing aids. The ear mold is the only part of the hearing aid that may be washed frequently; it should be washed daily with soap and water. Irrigation of the ear canal is done to remove impacted cerumen or a foreign body.

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Question Of The Day: Musculoskeletal Disorders

Q. A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

A. Hypoactive bowel sounds
B. Severe lower back pain
C. Sensory deficits in one arm
D. Weakness and atrophy of the arm muscles



Correct Answer: B

Reason: The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

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Question Of The Day: Infant

Q. A parent confides to the nurse that their 8-month-old infant is anxious. Which of the following suggestions by the nurse is most appropriate to help the mother lessen her anxiety about her infant?

A. Limit holding the infant to feeding times.
B. Talk quietly to the infant while he is awake.
C. Play music in his room for most of the day and night.
D. Have a close friend keep the infant for a few days.

Correct Answer: B

Reason: Infants are sensitive to stress in their caretakers. The best way to handle an anxious infant is to talk quietly to him, thereby soothing the infant. Limiting holding of the infant to feeding periods interferes with meeting the infant's needs for close contact, possibly compromising his ability to develop trust. Playing music in the room for most of the day and night will make it difficult for the infant to differentiate days from nights. Having a friend take the infant for several days will not necessarily take care of the problem because when the infant returns to the mother the same behaviors will recur unless the mother makes some changes. 

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Question Of The Day: Gastrointestinal Disorders

Q. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

A. Absence of nausea and vomiting.
B. Passage of mucus from the rectum.
C. Passage of flatus and feces from the colostomy.
D. Absence of stomach drainage for 24 hours.


Correct Answer: C

Reason: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.

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Question Of The Day: Cardiovascular Disorders

Q. A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification?

A. Class I.

B. Class II.

C. Class III.

D. Class IV.

Correct Answer: B

Reason: According to the New York Heart Association Cardiac Disease classification, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). The New York Heart Association Cardiac Disease Classification identifies Class II clients as having cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing, palpations, and fatigue. All of the client's other symptoms are within normal limits.

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Question Of The Day: The Neonate

Q. A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during his first 24 hours?

A. Administer insulin subcutaneously.
B. Administer a bolus of glucose I.V.
C. Provide frequent early feedings with formula.
D. Avoid oral feedings.

Correct Answer: C

Reason: The neonate of a mother with gestational diabetes may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia. Insulin shouldn't be administered because the neonate of a mother with gestational diabetes is at risk for hypoglycemia. A bolus of glucose given I.V. may cause rebound hypoglycemia. If glucose is given I.V., it should be administered as a continuous infusion. Oral feedings shouldn't be avoided because early, frequent feedings can help avoid hypoglycemia.

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Question Of The Day: Postpartum Period

Q. After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?

A. "I can take two aspirin if I get uterine cramps."
B. "Protamine sulfate should be available if I need it."
C. "I should use a soft toothbrush to brush my teeth."
D. "I can drink an occasional glass of wine if I desire."

Correct Answer: C

Reason: Successful teaching is demonstrated when the client says, "I should use a soft toothbrush to brush my teeth." Heparin therapy can cause the gums to bleed, so a soft toothbrush should be used to minimize this adverse effect. Use of aspirin and other nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Protamine sulfate is the antidote for heparin therapy. Vitamin K is the antidote for warfarin excess. Alcohol can inhibit the metabolism of oral anticoagulants and should be avoided.

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Question Of The Day: Antepartum Period

Q. A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should first:

A. perform a pelvic examination.
B. assess the client's blood pressure.
C. assess the fetal heart rate.
D. order a stat hemoglobin and hematocrit.



Correct Answer: C

Reason: The nurse should assess the fetal heart rate for distress or viability. She shouldn't attempt to perform a pelvic examination because of the possibility of placenta previa, which presents as bright red bleeding without abdominal pain. The nurse should assess the client's blood pressure after attempting to hear fetal heart tones. Ordering a hemoglobin and hematocrit is a physician intervention, not a nursing intervention.

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

Q. A client with a history of polysubstance abuse is admitted to the facility. He complains of nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance?

A. Alcohol
B. Cannabis
C. Cocaine
D. Opioids

Correct Answer: D

Reason: Piloerection, pupillary dilation, and lacrimation are specific to opioid withdrawal. A client with alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannabis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

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Question Of The Day: Psychotic Disorders

Q. The nurse should assess the client who is taking risperidone (Risperdal) 1 mg, orally twice a day for:

A. Insomnia.
B. Headache.
C. Anxiety.
D. Orthostatic hypotension.




Correct Answer: D

Reason: Significant orthostatic hypotension is associated with risperidone (Risperdal) therapy. The nurse should monitor the client's blood pressure sitting and standing and teach the client interventions to manage this adverse effect to prevent risk of injury. Although insomnia, headache, and anxiety are possible adverse effects of risperidone therapy, they are of less immediate concern than orthostatic hypotension.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client:

A. "You're a 28-year-old adult now, not a child who needs to be cared for."
B. "Your parents won't be around forever. After all, they are getting older."
C. "Your parents need a break, and you need a break from them."
D. "Your parents have been supportive and will continue to be even if you live apart."

Correct Answer: D

Reason: Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.

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Question Of The Day: School-age Child

Q. An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

A. Cullen's sign.
B. Koplik's spots.
C. Kernig's sign.
D. Chvostek's sign.





Correct Answer: C

Reason: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

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