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

Reason: 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

Reason: 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

Reason: 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

Reason: 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: 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

Reason: 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: Antepartum Period

Q. Which medication is considered safe during pregnancy?

A. Aspirin
B. Magnesium hydroxide
C. Insulin
D. Oral antidiabetic agents




Correct Answer: C

Reason: Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm. 

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

Q. A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate?

A. "Your doctor wants you to take it for at least 4 months."
B. "You've been drinking alcohol and eating very little."
C. "The vitamin is a nutritional supplement important to your health."
D. "The amount of vitamins in the alcohol you drink is very low."

Correct Answer: C

Reason: Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy. Although the statements about drinking alcohol and eating very little and that there is a low amount of vitamins in the alcohol consumed may be true, they fail to address the client's concerns directly and fail to provide the necessary information, as does telling the client that the doctor wants the client to take the vitamin for 4 months.

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Question Of The Day: Psychotic Disorders

Q. Which condition or characteristic is related to the cluster of symptoms associated with disorganized schizophrenia?

A. Odd beliefs
B. Flat affect
C. Waxy flexibility
D. Systematized delusions



Correct Answer: B

Reason: Flat affect (the lack of facial or behavioral manifestations of emotion) is related to disorganized schizophrenia. Other characteristics of disorganized schizophrenia include incoherence, loose associations, and disorganized behavior. Paranoid residual type schizophrenia is characterized by odd beliefs, unusual perceptions, and systematized delusions. Waxy flexibility, or maintaining the position the client is placed in, is seen in catatonic schizophrenia.

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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

Reason: 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

Reason: 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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This is How COVID-19 is Changing The Future of Nursing For Students and Tenured Nurses

COVID-19, the novel coronavirus that has changed the face of America for the  last several months, has forever changed the healthcare landscape. While the general population is learning to navigate the “new normal” nurses, nursing students, and prospective students are facing the unknown. As restrictions across the country continue to ease and states enter the green phase, the pandemic is far from over.

One of the most notable changes to nursing during the pandemic is the relaxation of state regulations for licensure. At the start of the pandemic, state boards of nursing allowed for temporarily changing certain requirements that affected nurses practicing in their states, due to the impact of the coronavirus on their healthcare workforce. Every state, territory, and the District of Columbia declared a state of emergency, allowing nurses licensed in other states to be fast-tracked for practice.

Currently, states are tightening restrictions again but many are currently looking at the importance of the Enhanced Nursing Compact License. With thirty-two states, and two more set to join in July 2020, the eNLC  can help solve the predicament that many states had at the start of the pandemic. If all states were part of the eNLC prior to COVID-19, nurses could have easily mobilized to areas of highest need, specifically Seattle and New York City.

So let’s break it down to how it is affecting nurses, nursing students, and prospective students. Unfortunately, most would say that COVID-19 has hurt the field of nursing because it has changed many opportunities that were once available to nurses such as flexibility in per diem jobs, raises, vacation time, and overtime shifts. Many healthcare systems have been forced to re-evaluate their budget and this has dramatically affected nurses and future nurses.

Prospective Students

◉ More colleges and universities are offering online and distance learning programs.

◉ Nursing programs are limiting incoming classes due to clinical placement restrictions.

◉ Prospective students are unable to tour nursing classrooms and lab facilities to determine compatibility with their needs.

◉ Due to limitations on class size, nursing programs are becoming increasingly competitive. Applying to multiple programs is essential to earning your well-deserved spot.

Nursing Students

◉ Many nursing clinical rotations have been canceled or suspended while others have been moved to COVID-19 testing sites.

◉ There has been a mass movement to online and distance learning education versus in-person instruction.

◉ Senior nursing students did not all graduate due to the suspension of in-person clinicals.

◉ The NCLEX examination was delayed at the start of the pandemic and now there is a backlog of students needing to take the exam.

     ◉ There have been many changes made to the NCLEX examination,
     ◉ Exam Time: Shortened from 6 hours to 4 hours
     ◉ Questions: Decreased the number of questions to pass the exam from 75 questions to 60 questions
     ◉ Maximum number of questions: Decreased from 265 questions to 130 questions
     ◉ No pre-test questions
     ◉ Research section questions of NCLEX have been removed
     ◉ Students must wear gloves and a mask

◉ Some nursing students are concerned for job opportunities after graduation as most healthcare companies instituted a hiring freeze due to the pandemic.

◉ New nursing jobs are expected to emerge from the pandemic, especially those in telehealth and remote work-from-home settings.

Current Nurses

◉ Increase in telehealth and remote work-from-home positions.

◉ More flexibility to work in different healthcare settings.

◉ Learn ICU skills quickly and with limited orientation.

◉ Travel nursing became extremely competitive during the height of the crisis but now travel nurses are struggling to find contracts as many hospitals are seeing a downward trend in patients.

◉ Ability to expand nursing skill set.

◉ Ability to function more autonomously at the bedside.

◉ Connection with patients as most hospitals and nursing homes has visitor restrictions and patients were often alone, especially those suffering from COVID-19.

◉ Focus on community and public nursing care versus individualized nursing care.

◉ Hospitals have taken a thoughtful look at finances and cut overtime, per diem nurses and instituted hiring and wage freezes during the pandemic. They have also limited vacation time.

◉ The safety of nursing staff has been an ongoing issue. Due to the focus on PPE and lack thereof in most hospitals, nurses are concerned about another wave of the pandemic. Most have had to reuse PPE for countless shifts which have left many to question the effectiveness of it.

◉ Nurses continue to work with fewer resources due to staffing shortages and budget cuts.

◉ Increased retirement due to concerns of catching COVID-19 in the workplace.

◉ Increase in compassion fatigue and decrease in self-care.

COVID-19 highlighted the need for nurses throughout the United States. As the nursing profession continues to grow, the shortage also continues to grow. Now as nurses fight to earn back quality and safety standards in hospitals, healthcare systems will continue to have high expectations of their nursing staff. During the pandemic, healthcare administrators used the attitude that “a nurse is a nurse is a nurse” but that is not true. Each nurse has a special skill set, whether they work in the OR, ER, ICU, or medical-surgical floor. Nurses can not simply be replaced by another nurse but this is now the current expectation.

The effects of COVID-19 will long be seen throughout the nursing profession and despite everything that it has taken from nurses, nursing students, and prospective nurses - the “Year of the Nurse” will continue to show that nurses are resilient, dedicated, and compassionate.

Source: nurse.org

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Question Of The Day: School-age Child

Q. Which of the following measures should the nurse include in the care plan for a child who is receiving high-dose methotrexate (amethopterin) therapy?

A. Keeping the child in a fasting state.
B. Obtaining a white blood cell (WBC) count.
C. Preparing for radiography of the spinal canal.
D. Collecting a specimen for urinalysis.



Correct Answer: B

Reason: Methotrexate is not highly toxic in low doses but may cause severe leukopenia at higher doses. It is customary and recommended for blood tests to be done before therapy to provide a baseline from which to study the effects of the drug on WBC count. Maintaining a fasting state, radiography of the spinal canal, and urinalysis are not necessary when this drug is administered.

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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

Reason: 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

Reason: 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

Reason: 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

Reason: 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

Reason: 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 Psychosocial Needs

Q. An Arab client with pneumonia has been admitted to the health care facility. What should the nurse avoid while conducting the interview of the client?

A. Giving a light handshake.
B. Maintaining eye contact.
C. Asking about the client's symptoms.
D. Asking about the client's medical history.



Correct Answer: B

Reason: While interviewing an Arab client, the nurse should avoid maintaining eye contact. In Arab culture, maintaining eye contact is sexually suggestive; if the nurse does so during the interview, it may give the wrong message to the client. However, the nurse may give a light handshake or ask about the client's personal life and medical history during the interview.

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Question Of The Day: Genitourinary Disorders

Q. 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

Reason: 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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Question Of The Day: Respiratory Disorders

Q. A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it:

A. is a respiratory depressant.
B. is a respiratory stimulant.
C. may induce bronchospasm.
D. inhibits the cough reflex.

Correct Answer: C

Reason: Acetylcysteine must be used cautiously in a client with asthma because it may induce bronchospasm. The drug isn't a respiratory depressant or stimulant. It's a mucolytic agent that decreases the viscosity of respiratory secretions by altering the molecular composition of mucus. Acetylcysteine doesn't inhibit the cough reflex.

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Question Of The Day: Neurosensory Disorders

Q. A potential concern when caring for an older adult who has diminished hearing and vision is the client's:

A. Feelings of disorientation.
B. Cognitive impairment.
C. Sensory overload.
D. Social isolation.



Correct Answer: D

Reason: Social isolation is a concern for an older adult who has diminished hearing and vision. Feeling disoriented may be related to cognitive problems rather than diminished hearing and vision. Diminished hearing and vision is related to the aging process and does not result in impairment of the older adult's thought processes. The client with impaired hearing and vision is unlikely to experience sensory overload.

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Question Of The Day: Endocrine and Metabolic Disorders

Q. A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, "I can't be expected to remember all this stuff." The nurse should recognize this response as most likely related to which of the following?

A. Moderate to severe anxiety.
B. Disinterest in the illness.
C. Early-onset dementia.
D. Normal reaction to learning a new skill.

Correct Answer: A

Reason: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for him to learn the steps of the blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes his lifestyle, it is unlikely that he is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate lessening anxiety would be questions to the nurse or requests to repeat part of the instruction.

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Question Of The Day: Immune and Hematologic Disorders

Q. A client receiving a blood transfusion begins to have chills and headache within the first 15 minutes of the transfusion. The nurse should first:

A. Administer acetaminophen.
B. Take the client's blood pressure.
C. Discontinue the transfusion.
D. Check the infusion rate of the blood.


Correct Answer: C

Reason: Chills and headache are signs of a febrile, nonhemolytic blood transfusion reaction and the nurse's first action should be to discontinue the transfusion as soon as possible and then notify the physician. Antipyretics and antihistamines may be ordered. The nurse would not administer acetaminophen without an order from the physician. The client's blood pressure should be taken after the transfusion is stopped. Checking the infusion rate of the blood is not a pertinent action; the infusion needs to be stopped regardless of the rate.

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Question Of The Day: Integumentary Disorders

Q. Following a small-bowel resection, a client develops fever and anemia. The surface surrounding the surgical wound is warm to the touch and necrotizing fasciitis is suspected. Another manifestation that suggests necrotizing fasciitis is:

A. erythema.
B. leukocytosis.
C. pressurelike pain.
D. swelling.

Correct Answer: C

Reason: Severe pressurelike pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulitis. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision?

A. Autonomy
B. Fidelity
C. Nonmaleficence
D. Veracity


Correct Answer: A

Reason: Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth.

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