Question Of The Day: The Nursing Process

Q. During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report?

A. Attach a copy to the client's records.
B. Highlight the mistake in the client's records.
C. Include the time and date of the incident.
D. Mention the name of the nursing assistant in the client records.

Correct Answer: C

Reason: The nurse should include the date and time of the incident in the incident report, the events leading up to it, the client's response, and a full nursing assessment. To prevent legal issues, the nurse should not attach the copy of the incident report to the client's records. Also to prevent litigation, the mistake should not be highlighted in the client's records. As the client report is a legal document, it should not contain the name of the nursing assistant.

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

Q. The client is receiving an I.V. infusion of 5% dextrose in normal saline running at 125 ml/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:

A. Discontinue the infusion.
B. Apply a warm soak to the site.
C. Stop the flow of solution temporarily.
D. Irrigate the needle with normal saline.

Correct Answer: A

Reason: Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the I.V. line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the I.V. line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's needs for fluid replacement. Infiltrated I.V. sites should not be irrigated; doing so will only cause more swelling and pain.

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Question Of The Day: Basic Physical Care

Q. Communicating with parents and children about health care has become increasingly significant because:

A. Consumers of health care cannot keep up with rapid advances in science.
B. The influence of the media and specialization have increased the complexity of managing health.
C. Nurse educators have recognized the value of communication.
D. Clients are more demanding that their rights be respected.

Correct Answer: B

Reason: Today's health care network includes many specialized areas, such as respiratory therapy, medicine, laboratory, social services, and technical monitoring, to name a few. Due to expanded media coverage of health care issues, parents are more aware of health care issues but cannot understand all the ramifications of possible health care decisions. Because of this expanded media coverage, health care consumers are more aware of advances in the science of health care. Nurses have always recognized the value of communication and that all nurses are teachers. Clients are more aware of their rights through media exposure and information disseminated by health care facilities. However, respect for the client's rights should be the nurse's concern as well and communicating with parents and children should not be impacted by a client's knowledge or demand for those rights.

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Question Of The Day: Genitourinary Disorders

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

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





Correct Answer: A

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

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Question Of The Day: Respiratory Disorders

Q. A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. The nurse's first action should be to:

A. Call for emergency assistance.
B. Attempt reinsertion of tracheostomy tube.
C. Position the client in semi-Fowler's position with the neck hyperextended.
D. Insert the obturator into the stoma to reestablish the airway.

Correct Answer: B

Reason: The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.

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Question Of The Day: Neurosensory Disorders

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

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

Correct Answer: A

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

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Question Of The Day: The Neonate

Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?

A. Rewarm the neonate gradually.
B. Rewarm the neonate rapidly.
C. Observe the neonate hourly.
D. Notify the physician when the neonate's temperature is normal.



Correct Answer: A

Reason: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.

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Question Of The Day: Postpartum Period

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

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



Correct Answer: D

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

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Question Of The Day: Antepartum Period

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

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




Correct Answer: B

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

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Question Of The Day: Psychotic Disorders

Q. A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.

Correct Answer: C

Reason: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff. When the client's request for a pass is refused by the primary care provider, he utters a stream of profanities. Which of the following statements best describes the client's behavior?

A. The client's anger is not intended personally.
B. The client's anger is a reliable sign of serious pathology.
C. The client's anger is an intended attack on the primary care provider's skills
D. The client's anger is a sign that his condition is improving.

Correct Answer: A

Reason: Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and are available for attack. The display of anger is rarely intended to be personal. Such behavior is not necessarily a sign of serious pathology but must be weighed in conjunction with other behaviors. An angry outburst is not an attack on a primary care provider's skills. While not necessarily pathologic, the client's behavior isn't a sign that his condition is improving.

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Question Of The Day: School-age Child

Q. On initial assessment of a 7-year-old child with rheumatic fever, which of the following would require contacting the primary care provider immediately?

A. Heart rate of 150 beats/minute.
B. Swollen and painful knee joints.
C. Twitching in the extremities.
D. Red rash on the trunk.



Correct Answer: A

Reason: A heart rate of 150 beats/minute is very high for a 7-year-old child and may indicate carditis. For this age group, the normal heart rate while awake is 70 to 110 beats/minute. Swollen and painful joints such as the knee are characteristic findings in the child with rheumatic fever and do not require immediate physician notification. Twitching in the extremities, known as chorea, is a characteristic finding in a child with rheumatic fever and does not require immediate physician notification. A red rash on the trunk typically indicates rheumatic fever and does not require immediate physician notification.

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Question Of The Day: Toddler

Q. When performing a physical assessment on an 18-month-old child, which of the following would be best?

A. Have a parent hold the toddler.
B. Assess the ears and mouth first.
C. Carry out the assessment from head to toe.
D. Assess motor function by having the child run and walk.



Correct Answer: A

Reason: The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler. Assessment should begin with noninvasive assessments first while the child is quiet. Typically these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last. Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet. Having a toddler run and be active may make it difficult to settle the child down after the physical exertion. 

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Question Of The Day: The Nursing Process

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

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

Correct Answer: D

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

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

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

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

Correct Answer: B

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

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Question Of The Day: Genitourinary Disorders

Q. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

A. Bacterial vaginitis
B. Gonorrhea
C. Genital herpes
D. Human papillomavirus (HPV)

Correct Answer: B

Reason: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

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Question Of The Day: Respiratory Disorders

Q. A client with pneumonia has a temperature of 102.6° F (39.2° C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?

A. Position changes every 4 hours.
B. Nasotracheal suctioning to clear secretions.
C. Frequent linen changes.
D. Frequent offering of a bedpan.


Correct Answer: C

Reason: Frequent linen changes are appropriate for this client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client's productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.

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Top 5 Fastest Paths to Becoming a Nurse

Maybe you’ve always wanted to work in healthcare, or maybe you just need to get into a career that gives you a steady income with plenty of job security — and STAT. Becoming a nurse does not have to be a long drawn process. There are many ways to become a nurse, some in as little as 11 months.

1. Licensed Practical Nurse (LPN)

If your goal is to start working as soon as possible, LPN is a great initial step. Most programs are 11 months, about 3 semesters, or 40 credit hours. This route may or may not include a clinical component within the curriculum, and many people report being able to work part-time throughout the program if necessary.

As an LPN, you can work at the bedside, in clinics, and in many other places where nurses are hired. It’s important to know that the scope of practice for an LPN is not the same as an RN. You will be restricted in some practices — such as administering IV medication; your facility should provide guidance on these restrictions. Salaries for LPNs are also about half of that of a registered nurse.

If the LPN route sounds like it would fit your lifestyle best but you know you will want to grow in your career, there are many LPN to RN programs that can help you get to the next level of nursing when you are ready and able to take that step.

2. Associate Degree in Nursing

Associate degree nursing programs are typically 2 years in length. You will graduate with an RN license and you will have a full scope of practice of a registered nurse, in comparison to an LPN. Your pay will begin on the scale of a registered nurse. However, in many places, the salary ceiling is lower than for a bachelor’s prepared nurse.

The restrictions to an ADN are typically career growth — positions like management, leadership, or clinical nurse specialists are reserved for bachelor’s prepared nurses. Just like the LVN to RN bridge, there are many ADN to BSN programs that can help you advance your career when the time is right for you.

3. Accelerated Bachelors of Science in Nursing

This option is available for people who already hold a bachelor’s degree in another field and would like to accomplish a BSN in a quick time. To enter an accelerated bachelor’s program, one must have a degree in any other field, accomplish the mandated prerequisite courses, and have a strong GPA upon applying. These programs range from 12 months to 2 years.

4. Nurse Apprenticeships

Nurse Apprenticeships are programs offered by hospitals and academic programs to allow those who are in the process of obtaining their nursing degree, to begin working while in school. Although this doesn’t necessarily shorten the length of your nursing coursework, this does allow you to earn money while in the program, and provides an avenue of resources for you to land a job as soon as — or even before — you graduate. Learning on the job and making connections is a great way to jumpstart your career. Look for positions titled: “nurse apprenticeship,” “nurse technician,” or “nurse internship.”

5. Tips on speeding through your nursing program

If you are interested in being time-efficient with school, there are many practical ways to get through the program quickly. Many schools offer the option of not taking time off between semesters (during the summer for example) and if you feel that you can afford to sacrifice a summer vacation, push through those months and graduate a little earlier.

Working during school may be a necessity for you, but if it can be cut out of your schedule, you may find that you can focus and get through more classes or take more credits with the added time. Finally, finding a mentor or a tutor that can help you get through confusing times in class or in clinicals can keep you on track. Remember that schools have ample resources that if used properly, can speed you over to your destination!

Source: nurse.org

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Question Of The Day: Neurosensory Disorders

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

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

Correct Answer: C

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

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Question Of The Day: Musculoskeletal Disorders

Q. A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

A. Head of the bed elevated 45 degrees
B. Prone
C. Supine with feet raised
D. Supine with the head lower than the trunk


Correct Answer: A

Reason: After a myelogram, positioning depends on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The prone and supine positions are contraindicated when a water-soluble contrast dye is used. The client should be positioned supine with the head lower than the trunk after an air-contrast study.

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Question Of The Day: Endocrine and Metabolic Disorders

Q. A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

A. Administer half of the client's typical morning insulin dose as ordered.
B. Administer an oral antidiabetic agent as ordered.
C. Administer an I.V. insulin infusion as ordered.
D. Administer the client's normal daily dose of insulin as ordered.

Correct Answer: A

Reason: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

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