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: Basic Physical Care

Q. A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:

A. monitoring of arterial oxygen saturation (SaO2).

B. arterial blood gas (ABG) studies.

C. chest auscultation.

D. a chest X-ray.

Correct Answer: D

Reason: Chest X-ray confirms diagnosis by revealing air or fluid in the pleural space. SaO2 values may initially decrease with a pneumothorax but typically return to normal within 24 hours. ABG studies may show hypoxemia, possibly with respiratory acidosis and hypercapnia but these are not necessarily related to a pneumothorax. Chest auscultation will determine overall lung status, but it's difficult to determine if the chest has reexpanded sufficiently.

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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: 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: Oncologic Disorders

Q. The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

A. Carcinoembryonic antigen (CEA) test after age 50

B. Proctosigmoidoscopy after age 30

C. Annual digital examination after age 40

D. Barium enema after age 20

Correct Answer: C

Reason: The American Cancer Society recommends an annual digital examination after age 40 for the purpose of detecting colorectal cancer. The CEA test is performed on clients who have already been treated for colorectal cancer. It helps monitor a client's response to treatment as well as detect metastasis or recurrence. Proctosigmoidoscopy is recommended every 3 to 5 years for people older than age 50. Barium enema isn't a screening test.

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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: Intrapartum Period

Q. A nurse is assessing a woman in labor. Her cervix is dilated 8 cm. Her contractions are occurring every 2 minutes. She's irritable and in considerable pain. What type of breathing should the nurse instruct the woman to use during the peak of a contraction?

A. Deep breathing
B. Shallow chest breathing
C. Deep, cleansing breaths
D. Chest panting

Correct Answer: B

Reason: Shallow chest breathing is used during the peak of a contraction during the transitional phase of labor. Deep breathing can cause a woman to hyperventilate and feel light-headed, with numbness or tingling in her fingers or toes. A deep, cleansing breath taken at the beginning and end of each breathing exercise can help prevent hyperventilation. Chest panting may be used to prevent a woman from pushing before the cervix is fully dilated. 

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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: Mood, Adjustment, and Dementia Disorders

Q. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.

B. The pain is real to the client, even though the pain may not have an organic etiology.

C. The pain is less than would be expected as a result of the underlying disorder the client identifies.

D. The pain is what would be expected as a result of the underlying disorder the client identifies.

Correct Answer: B

Reason: In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause for it. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic trust-based relationship. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is usually in excess of what the pathologic cause would normally be expected to produce.

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Question Of The Day: Anxiety Disorders

Q. A nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

A. By setting aside times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as possible
C. By calling attention to or trying to prevent the behavior
D. By discouraging the client from verbalizing his anxieties

Correct Answer: A

Reason: The nurse should set aside times during which the client is free to focus on his compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize his anxieties to help distract attention from his compulsive behavior. 

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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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Question Of The Day: The Nursing Process

Q. A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of:

A. Nursing informatics.
B. Electronic medical records.
C. Telemedicine.
D. Computerized documentation

Correct Answer: A

Reason: Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.

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Question Of The Day: Basic Physical Assessment

Q. Twenty-four hours after a bone marrow aspiration, the nurse evaluates which of the following as an appropriate client outcome?

A. The client maintains bed rest.
B. There is redness and swelling at the aspiration site.
C. The client requests morphine sulfate for pain.
D. There is no bleeding at the aspiration site.



Correct Answer: D

Reason: After a bone marrow aspiration, the puncture site should be checked every 10 to 15 minutes for bleeding. For a short period after the procedure, bed rest may be ordered. Signs of infection, such as redness and swelling, are not anticipated at the aspiration site. A mild analgesic may be ordered. If the client continues to need the morphine for longer than 24 hours, the nurse should suspect that internal bleeding or increased pressure at the puncture site may be the cause of the pain and should consult the physician.

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

Q. When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

A. 15 degrees.
B. 30 degrees.
C. 45 degrees.
D. 90 degrees.



Correct Answer: D

Reason: When giving an I.M. injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering an intradermal injection. A 30-degree angle isn't used for any type of injection. The nurse may use a 45- or 90-degree angle when giving a subcutaneous injection.

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Question Of The Day: Basic Physical Care

Q. A primiparous woman has recently delivered a term infant. Priority teaching for the patient includes information on:

A. Sudden infant death syndrome (SIDS)
B. Breastfeeding
C. Infant bathing
D. Infant sleep-wake cycles



Correct Answer: B

Reason: Breastfed infants should eat within the first hour of life and approximately every 2 to 3 hours. Successful breastfeeding will likely require sustained support, encouragement, and instruction from the nurse. Information on SIDS, infant bathing, and sleep-wake cycles are also important topics for the new parent, but they can be covered at any time prior to discharge.

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