Question Of The Day: Gastrointestinal Disorders

Q. A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

A. Straw-colored urine
B. Reduced hematocrit
C. Clay-colored stools
D. Elevated urobilinogen in the urine



Correct Answer: C

Reason: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

Read More

Question Of The Day: Oncologic Disorders

Q. A client who is undergoing radiation therapy develops mucositis. Which of the following interventions should be included in the client's plan of care?

A. Increase mouth care to twice per shift.
B. Provide the client with hot tea to drink.
C. Promote regular flossing of teeth.
D. Use half-strength hydrogen peroxide on mouth ulcers.

Correct Answer: C

Reason: Mucositis is an inflammation of the oral mucosa caused by radiation therapy. It is important that the client with mucositis receive meticulous mouth care, including flossing, to prevent the development of an infection. Mouth care should be provided before and after each meal, at bedtime, and more frequently as needed. Extremes of temperature should be avoided in food and drink. Half-strength hydrogen peroxide is too harsh to use on irritated tissues.

Read More

Question Of The Day: Cardiovascular Disorders

Q. A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?

A. Opening snap
B. Graham Steell's murmur
C. Ejection click
D. Pericardial friction rub


Correct Answer: D

Reason: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week following an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steell's murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole, it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole.

Read More

Question Of The Day: Postpartum Period

Q. A nurse is preparing to perform a postpartum assessment on a client who gave birth 5 hours ago. Which precaution should the nurse plan to take for this procedure?

A. Washing the hands
B. Washing the hands and wearing latex gloves
C. Washing the hands and wearing latex gloves and a barrier gown
D. Washing the hands and wearing latex gloves, a barrier gown, and protective eyewear

Correct Answer: B

Reason: During a postpartum assessment, the nurse is likely to come into contact with the client's blood or body fluids, especially when examining the perineal region. Therefore, the nurse must wear latex gloves; hand washing alone would neither provide adequate protection nor comply with universal precautions. The nurse should wear a barrier gown and protective eyewear in addition to latex gloves only when anticipating splashing of blood or body fluids such as during childbirth. Splashing isn't likely to occur during a postpartum assessment.

Read More

Question Of The Day: Intrapartum Period

Q. A client who has been in the latent phase of the first stage of labor is transitioning to the active phase. During the transition, the nurse expects to see which client behavior?

A. A desire for personal contact and touch
B. A full response to teaching
C. Fatigue, a desire for touch, and quietness
D. Withdrawal, irritability, and resistance to touch

Correct Answer: D

Reason: During the transition to the active phase of the first stage of labor, increased pain typically makes the client withdrawn, irritable, and resistant to touch. During the latent phase (the early part of the first stage of labor), when contractions aren't intensely painful, the client typically desires personal contact and touch and responds to teaching and interventions. Fatigue, a desire for touch, and quietness are common during the third and fourth stages of labor.

Read More

Question Of The Day: Antepartum Period

Q. A client who's 7 weeks pregnant comes to the clinic for her first prenatal visit. She reports smoking 20 to 25 cigarettes per day. When planning the client's care, the nurse anticipates informing her that if she doesn't stop smoking, her fetus may be at risk for:

A. spina bifida.
B. tetralogy of Fallot.
C. low birth weight.
D. hydronephrosis.

Correct Answer: C

Reason: The risk of intrauterine growth retardation may increase with the number of cigarettes a pregnant woman smokes. Neural tube defects (such as spina bifida), cardiac abnormalities (such as tetralogy of Fallot), and renal disorders (such as hydronephrosis) are associated with multifactorial genetic inheritance, not maternal cigarette smoking.

Read More

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

Q. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?

A. Seizures
B. Shivering
C. Anxiety
D. Chest pain

Correct Answer: A

Reason: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Read More

Question Of The Day: Psychotic Disorders

Q. At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine (Zyprexa) even though it controls his symptoms of schizophrenia better than other medications. "I have gained 20 lb already. I can't stand any more." Which response by the nurse is most appropriate?

A. "I don't think you look fat, why do you think so?"
B. "I can help you with a diet and exercise plan to keep your weight down."
C. "You can be switched to another medicine."
D. "Your weight gain will level off if you stay on the medication 3 more months."

Correct Answer: B

Reason: Helping the client control his weight is the most appropriate approach. The nurse's contradiction of the client's complaint is inappropriate. Most atypical antipsychotics cause weight gain and are not a solution to the weight gain. There is little evidence that weight gain from taking olanzapine decreases with time.

Read More

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

Q. A client diagnosed with a cognitive disorder is showing signs of confusion, short-term memory loss, and a short attention span. Which of the following therapy groups would be best suited for this client?

A. Insight-oriented.

B. Medication management.

C. Problem solving.

D. Reality-orientation.

 

Correct Answer: D

Reason: Because the client has confusion, short-term memory loss, and a short attention span, a reality-orientation group is recommended to help the client maintain an optimal level of functioning, decrease isolation, and increase self-esteem. Focus is on the "here and now" and provides reality testing, structure, and social support. A client with a cognitive disorder is unlikely to benefit from an insight-oriented group, where the focus is on role relationships. Short-term memory loss and confusion interfere with the ability to learn about medication management. Short-term memory loss and confusion interfere with the ability to describe and solve problems.

Read More

Question Of The Day: School-age Child

Q. According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?

A. Trust versus mistrust
B. Initiative versus guilt
C. Industry versus inferiority
D. Identity versus role confusion



Correct Answer: C

Reason: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.

Read More

Question Of The Day: Preschooler

Q. A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first?

A. Obtain an order for sedation for the child.
B. Assess for an irregular heart rate and rhythm.
C. Explain to the child that it will only hurt for a short time.
D. Place the child in a knee-to-chest position.

Correct Answer: D

Reason: The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

Read More

Question Of The Day: Infant

Q. An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?

A. Encouraging the infant to hold a bottle
B. Keeping the infant on bed rest to conserve energy
C. Rotating caregivers to provide more stimulation
D. Maintaining a consistent, structured environment

Correct Answer: D

Reason: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

Read More

Question Of The Day: The Nursing Process

Q. Which of the following should be included in the plan of care for a client with a surgical wound that requires a wet-to-dry dressing?

A. Place a dry dressing in the wound.
B. Use Burrow's solution to wet the dressing.
C. Pack the wet dressing tightly into the wound.
D. Cover the wet packing with a dry sterile dressing.



Correct Answer: D

Reason: A wet-to-dry dressing should be able to dry out between dressing changes. Thus, the dressing should be moist, not dry, when applied. As the moist dressing dries, the wound will be debrided of necrotic tissue, exudate, and so forth. Normal saline is most commonly used to moisten the sponge; Burrow's solution will irritate the wound. The sponge should not be packed into the wound tightly because the circulation to the site could be impaired. The moist sponge should be placed so that all surfaces of the wound are in contact with the dressing. Then the sponge is covered and protected by a dry sterile dressing to prevent contamination from the external environment.

Read More

An Open Letter To The New Grad Nurses of 2020

I feel the need to apologize for the state of our current profession. By saying that, I don’t mean anything negative towards nursing in general, it’s actually quite contrary. I have more pride than ever in our profession.

I worry, however, that your first year will bring so many different challenges and obstacles that I didn’t have to face as a new nurse. The past four months have taken a toll on nurses worldwide, and I fear that the enthusiasm and zest for this profession will be muddled under a veil of exhaustion and compassion fatigue. Just know that although we may not greet you with streamers and kazoos, behind our tired eyes and blistered faces we are ecstatic to welcome you into our family.

This year’s group of new nurses face an uphill learning curve that hasn’t been experienced before. These ever-changing scenarios will be frustrating to navigate, and I can’t imagine the added stress you will be under to learn the nuances of this job in the midst of a Pandemic. 

◉ It’s hard enough learning the skills, time management, and medications, but now hospitals have policies that change faster than a woman changes out of her Spanx after a long night out.

◉ Hospitals have shortened orientations and eliminated residency programs as a result of budget cuts and an increasing demand for full time nurses.

◉ Since the development of COVID + units, nurses often float between departments at a higher frequency than normal which may result in an inconsistent staff to learn beside.

Show Me Nursing Programs

I urge you to find your people. Regardless of your department or hospital, there are always people around you ready and willing to help. Although you sometimes have to look harder to find them than others, find the coworkers that you feel safe asking questions to, will laugh with you at your mistakes, and will take the additional 30 seconds to help you navigate your way. Sometimes these people will be your preceptors, and other times it might be your Respiratory Therapist. On tough days when nothing feels right, text or call a friend from nursing school and commiserate together on the challenges and difficulties of this season. Oftentimes, the most meaningful comfort you can receive is the affirmation of a friend who is in the same scenario that you are walking through. Nursing is far from an independent profession, it’s the “you hold this butt cheek, I’ll hold the other” teamwork and reliability that carries us through.

I write this to you, beloved new grad, to tell you that although you are entering this profession at an unprecedented time, I know that you will come out of this experience far stronger than you could ever imagine. You have already proven your resiliency by graduating in unconventional ways, fighting for a position regardless of the potential dangers, and continually showing up despite the uncertainty in healthcare today. When you feel like you have hit your breaking point, which is an incredibly normal and predictable emotion to feel in those first few months, just remember that you are stronger than your surroundings.

Source: nurse.org

Read More

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

Q. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?

A. Breakthrough bleeding.
B. Severe calf pain.
C. Mild headache.
D. Weight gain of 3 lb.




Correct Answer: B

Reason: Women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of deep vein thrombosis. Breakthrough bleeding, mild headache, or weight gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment.

Read More

Question Of The Day: Basic Psychosocial Needs

Q. The health care provider at a prenatal clinic has ordered multivitamins for a woman who is 3 months' pregnant. The client calls the nurse to report that she has gone to the pharmacy to fill her prescription but is unable to buy it as it costs too much. The nurse should refer the client to:

A. The charge nurse.
B. The hospital finance office.
C. Her hospital social worker.
D. Her insurance company.

Correct Answer: C

Reason: The social worker is available to assist the client in finding services within the community to meet client needs. This individual is able to provide the names of pharmacies within the community that offer generic substitutes or others that utilize the client's insurance plan. The charge nurse of the unit would be able to refer the client to the social worker. The hospital finance office does not handle this type of situation and would refer the client back to the unit. The client's insurance company deals with payments for health care and would refer the client back to the local setting.

Read More

Question Of The Day: Basic Physical Care

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

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

Correct Answer: B

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

Read More

Question Of The Day: Genitourinary Disorders

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

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


Correct Answer: D

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

Read More

Question Of The Day: Respiratory Disorders

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

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



Correct Answer: D

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

Read More

Question Of The Day: Endocrine and Metabolic Disorders

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

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


Correct Answer: D

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

Read More