It has to go in a custom footer (not html module) to work*. The source, which also has some interesting thoughts on the desirability of disabling right click, is below: *Using in a custom footer:replace all code in xslt box with this: ]]>


Saturday, December 23, 2006

December 2006 Nursing Board Exam Update, PBSN Forum

December 2006 Nursing Board Exam Update

I will just repost what has been posted earlier because still many people that join the chat ask "When will the examination results come out?"

December 2006 Nursing Board Exam results will be out on the 2nd week to the 3rd week of January. I am still hoping that the results will come out a bit earlier though. Yes I know, That waiting is the killer... not the exam itself.

PBSN Forum

PinoyBSN is currently preparing its new forum. It's main purpose is to help the nursing student go through the hardship of making NCPs, researching, board exam and all other stuffs. To the best of our knowledge, The administrators and contributors will reach out to help in anyway we can. The forum will also be used as means of converging information, sharing experiences and simply making friends. This will help not only the students but the helpers as well, with teaching... comes learning.

I thought of creating forums long before the arrival of the GABBLY Chat, but the board exam prevented me from doing it. A thing about what forum can give that a chat software like gabbly could not is the element of permanence. A lot of student's question was answered in gabbly, but was it recorded? It is merely beginning to be cyclical when one question is repeatedly asked over and over again. With the forum, questions can be archived and be looked back for reference.

In the meantime, happy holidays!

Friday, December 22, 2006

OCHSNER HOSPITAL of New Orleans, Louisiana To Conduct Interview

OCHSNER HOSPITAL of New Orleans, Louisiana To Conduct Interview

The OCHSNER HOSPITAL of New Orleans, Louisiana thru their US Principal, Globehealth Resources, LLC of Texas would like to hire 50 additional Registered Nurses to be assigned in their expansion hospitals in New Orleans.

Only those who passed their NCLEX or CGFNS would be considered for interview.

The interview will be held on January 19, 2007, 8PM (via WEBCAM) at the G&P Manpower Services offices, 2/F GLC Building, T.M. Kalaw corner A. Mabini Street, Ermita, Manila.

OCHSNER Hospital was recently in Manila last November 28-30 and December 01, 2006 and conducted their interview at the Manila Diamond Hotel. Out of a total of 290 Nurses interviewed, 105 were lucky enough to have been hired and given outright Job Offers. This recent interview did not require the Nurses to have outright US credentials but were given financial assistance to complete all exams.

However, the forthcoming January 19, 2007 interview would require Nurses to have finished & passed their NCLEX or CGFNS exams already.

Applications will only be thru on-line. Please e-mail all resumes at:

Addressed to MR. RENE L. VILLARTA, Recruitment Director
CODE: Ochsner- 01-19-07

Our other interview schedule will be this coming March, 2007 (with or w/o NCLEX or CGFNS). Resumes should also be e-mailed at the e-mail address above.

Employment will be on a Direct-Hire Basis. Absolutely, NO Placement Fees will be collected whatsoever!

Wednesday, December 20, 2006

60 Item Medical Surgical Nursing : Musculoskeletal Examination

60 Item Medical Surgical Nursing : Musculoskeletal Examination

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

a. Supine
b. Semi Fowler's
c. Orthopneic
d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal traction?

a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortenend, adducted, and extremely rotated
d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

a. Supine c. Sim's
b. Prone d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client's range of motion activities without pain
d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

a. Client's position
b. Rope/pulley system
c. Amount of weight
d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

a. Increase in the temperature
b. Change in color
c. Edema
d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses:

a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

a. "I will take my vitamins while I am on this drug"
b. "I must not drink any alcohol while I'm taking this drug"
c. I should brush my teeth after every meal"
d. "I will continue taking my birth control pills"

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss
b. Osteoporosis d. Local joint pain

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

a. At bedtime c. Immediately after meal
b. On arising d. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?

a. Internal rotation c. Shortening of the affected leg
b. Muscle flaccidity d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

a. Axillae
b. Elbows
c. Upper arms
d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage
b. Infection
c. Deformity
d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?

a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?

a. Rales c. Generalized edema
b. Jaundice d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

a. Homan's sign c. Tenderness
b. Pain d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?

a. Divertional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity
b. Presence of a "hot spot" on the cast
c. Diminished distal pulse
d. Dependent edema

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:

a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:

a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately:

a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:

a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

Click here for the correct answers and rationale

Tuesday, December 19, 2006

40 items Comprehensive NCLEX review

1. Which individual is at greatest risk for developing hypertension?

A) 45 year-old African American attorney
B) 60 year-old Asian American shop owner
C) 40 year-old Caucasian nurse
D) 55 year-old Hispanic teacher

2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the emergency department. Which of these orders should the nurse do first?

A) Gastric lavage PRN
B) Acetylcysteine (mucomyst) for age per pharmacy
C) Start an IV Dextrose 5% with 0.33% normal saline to keep vein open
D) Activated charcoal per pharmacy

3. Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure?

A) angina at rest
B) thrombus formation
C) dizziness
D) falling blood pressure

4. A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is

A) Maintain fluid and electrolyte balance
B) Control nausea
C) Manage pain
D) Prevent urinary tract infection

5. What would the nurse expect to see while assessing the growth of children during their school age years?

A) Decreasing amounts of body fat and muscle mass
B) Little change in body appearance from year to year
C) Progressive height increase of 4 inches each year
D) Yearly weight gain of about 5.5 pounds per year

6. At a community health fair the blood pressure of a 62 year-old client is 160/96. The client states “My blood pressure is usually much lower.” The nurse should tell the client to

A) go get a blood pressure check within the next 48 to 72 hours
B) check blood pressure again in 2 months
C) see the health care provider immediately
D) visit the health care provider within 1 week for a BP check

7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission?

A) A middle aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago
B) A young adult with diabetes mellitus Type 2 for over 10 years and admitted with antibiotic induced diarrhea 24 hours ago
C) An elderly client with a history of hypertension, hypercholesterolemia and lupus, and was admitted with Stevens-Johnson syndrome that morning
D) An adolescent with a positive HIV test and admitted for acute cellulitus of the lower leg 48 hours ago

8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:

A) Should be taken in the morning
B) May decrease the client's energy level
C) Must be stored in a dark container
D) Will decrease the client's heart rate

9. A 3 year-old child comes to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling and suprasternal retractions. What should the nurse do first?

A) Prepare the child for x-ray of upper airways
B) Examine the child's throat
C) Collect a sputum specimen
D) Notify the healthcare provider of the child's status

10. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school age child for evaluation?

A) Polyphagia
B) Dehydration
C) Bed wetting
D) Weight loss

11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection?

A) Trichomoniasis
B) Chlamydia
C) Staphylococcus
D) Streptococcus

12. An RN who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN?

A) A middle-aged client who says "I took too many diet pills" and "my heart feels like it is racing out of my chest."
B) A young adult who says "I hear songs from heaven. I need money for beer. I quit drinking 2 days ago for my family. Why are my arms and legs jerking?"
C) An adolescent who has been on pain medications for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10
D) An elderly client who reports having taken a "large crack hit" 10 minutes prior to walking into the emergency room

13. When teaching a client with coronary artery disease about nutrition, the nurse should emphasize

A) Eating 3 balanced meals a day
B) Adding complex carbohydrates
C) Avoiding very heavy meals
D) Limiting sodium to 7 gms per day

14. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain break through for morphine drip is not working?

A) The client complains of discomfort at the IV insertion site
B) The client states "I just can't get relief from my pain."
C) The level of drug is 100 ml at 8 AM and is 80 ml at noon
D) The level of the drug is 100 ml at 8 AM and is 50 ml at noon

15. The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response?

A) Electrical energy fields
B) Spinal column manipulation
C) Mind-body balance
D) Exercise of joints

16. The nurse is performing a neurological assessment on a client post right CVA. Which finding, if observed by the nurse, would warrant immediate attention?

A) Decrease in level of consciousness
B) Loss of bladder control
C) Altered sensation to stimuli
D) Emotional lability

17. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time?

A) Positive sweat test
B) Bulky greasy stools
C) Moist, productive cough
D) Meconium ileus

18. The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs 2 hours ago. The nurse should

A) Place a call to the client's health care provider for instructions
B) Send him to the emergency room for evaluation
C) Reassure the client's wife that the symptoms are transient
D) Instruct the client's wife to call the doctor if his symptoms become worse

19. Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiograph test?

A) Client must be NPO before the examination
B) Enema to be administered prior to the examination
C) Medicate client with Lasix 20 mg IV 30 minutes prior to the examination
D) No special orders are necessary for this examination

20. The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He asks the nurse why he must wait 6 weeks before having sexual intercourse. What is the best response by the nurse to this question?

A) "You need to regain your strength before attempting such exertion."
B) "When you can climb 2 flights of stairs without problems, it is generally safe."
C) "Have a glass of wine to relax you, then you can try to have sex."
D) "If you can maintain an active walking program, you will have less risk."

21. A triage nurse has these 4 clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first?

A) A 2 month old infant with a history of rolling off the bed and has buldging fontanels with crying
B) A teenager who got a singed beard while camping
C) An elderly client with complaints of frequent liquid brown colored stools
D) A middle aged client with intermittent pain behind the right scapula

22. While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child's developmental needs?

A) "I want to protect my child from any falls."
B) "I will set limits on exploring the house."
C) "I understand the need to use those new skills."
D) "I intend to keep control over our child."

23. The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is

A) Verify correct placement of the tube
B) Check that the feeding solution matches the dietary order
C) Aspirate abdominal contents to determine the amount of last feeding remaining in stomach
D) Ensure that feeding solution is at room temperature

24. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued?

A) Narrowed QRS complex
B) Shortened "PR" interval
C) Tall peaked T waves
D) Prominent "U" waves

25. A nurse prepares to care for a 4 year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?

A) The muscles
B) The cerebellum
C) The kidneys
D) The leg bones

26. The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to

A) Achieve harmony
B) Maintain a balance of energy
C) Respect life
D) Restore yin and yang

27. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to

A) Increase fluids that are high in protein
B) Restrict fluids
C) Force fluids and reassess blood pressure
D) Limit fluids to non-caffeine beverages

28. A client has a Swan-Ganz catheter in place. The nurse understands that this is intended to measure

A) Right heart function
B) Left heart function
C) Renal tubule function
D) Carotid artery function

29. A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is

A) Start a peripheral IV
B) Initiate closed-chest massage
C) Establish an airway
D) Obtain the crash cart

30. A client is receiving digoxin (Lanoxin) 0.25 mg. Daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg. B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider?

A) Blood pressure 94/60
B) Heart rate 76
C) Urine output 50 ml/hour
D) Respiratory rate 16

31. While assessing a 1 month-old infant, which finding should the nurse report immediately?

A) Abdominal respirations
B) Irregular breathing rate
C) Inspiratory grunt
D) Increased heart rate with crying

32. The nurse practicing in a maternity setting recognizes that the post mature fetus is at risk due to

A) Excessive fetal weight
B) Low blood sugar levels
C) Depletion of subcutaneous fat
D) Progressive placental insufficiency

33. The nurse is caring for a client who had a total hip replacement 4 days ago. Which assessment requires the nurse’s immediate attention?

A) I have bad muscle spasms in my lower leg of the affected extremity.
B) "I just can't 'catch my breath' over the past few minutes and I think I am in grave danger."
C) "I have to use the bedpan to pass my water at least every 1 to 2 hours."
D) "It seems that the pain medication is not working as well today."

34. A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding may indicate the client is experiencing a negative side effect from the medication?

A) Weight gain of 5 pounds
B) Edema of the ankles
C) Gastric irritability
D) Decreased appetite

35. A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her obstetric history, which includes 3 year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information?

A) Gravida 4 para 2
B) Gravida 2 para 1
C) Gravida 3 para 1
D) Gravida 3 para 2

36. The nurse is caring for a client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?

A) Apply dressing using sterile technique
B) Improve the client's nutrition status
C) Initiate limb compression therapy
D) Begin proteolytic debridement

37. A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethizine hydrochloride (Phenergan) 50 mg IM to a pre-operative client. Which action should the nurse take first?

A) Raise the side rails on the bed
B) Place the call bell within reach
C) Instruct the client to remain in bed
D) Have the client empty bladder

38. Which of these statements best describes the characteristic of an effective reward-feedback system?

A) Specific feedback is given as close to the event as possible
B) Staff are given feedback in equal amounts over time
C) Positive statements are to precede a negative statement
D) Performance goals should be higher than what is attainable

39. client with multiple sclerosis plans to begin an exercise program. In addition to discussing the benefits of regular exercise, the nurse should caution the client to avoid activities which

A) Increase the heart rate
B) Lead to dehydration
C) Are considered aerobic
D) May be competitive

40. During the evaluation of the quality of home care for a client with Alzheimer's disease, the priority for the nurse is to reinforce which statement by a family member?

A) At least 2 full meals a day is eaten.
B) We go to a group discussion every week at our community center.
C) We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
D) The medication is not a problem to have it taken 3 times a day.


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As the need for nurses swells, the foreign-born step up

As the need for nurses swells, the foreign-born step up
By Paula Bock

The Seattle Times


TACOMA, Wash. - Of all the differences between hospital life in her native Philippines and here, in Washington state, one in particular has stuck with Maricris Espino, R.N.

It's not so much the salary (though she earns in two days the equivalent of a month's wages in her home country), or the technology (I.V. pumps, fancy electric beds), or the hospital hierarchy in which nurses examine patients and make suggestions to doctors.

What so often strikes Espino when she walks into a patient's room is that they're alone.

In the Philippines, patients are almost never alone. Their bedsides are cluttered with relatives to help with baths, meals, brushing teeth. The hospital wards are filled with the aroma of chicken adobo and pork asado brought in from home or a favorite hawker's cart rather than carefully calculated portions of antiseptic hospital food.

"In the Philippines," Espino recalls, "you don't have someone coming up to the nurses' station to say, 'My mom has to go to the bathroom.' Here, the concept is different. Even if the family is in the room, they won't touch their parents. They're not going to clean up the father or mother. Maybe they're afraid they're going to drop the patient. Or partly it's culture. In the Philippines, (patients) would prefer their daughter is going to see them naked rather than other people. Here, they'd prefer a nurse.

"Here, I do everything. Give them medication. Take them to the bathroom. Give them a bath. I don't mind, but y'know, I feel sorry for the patients who have nobody. ... When my mom was sick, we did everything."

Three years ago, Espino left her homeland and her dying diabetic mother to start a new job and a new life as a nurse at Allenmore Hospital in Tacoma, Wash. She was 31, a wife, a mother of two, the only sibling with the earning potential to pay her mom's medical bills.

"My presence there would have filled up her loneliness," Espino says, "but I could see I have my family to take care of. And I knew she was going to get even sicker eventually and I would have to pay for it."

Espino was one of 47 nurses recruited from the Philippines to relieve staffing shortages at two of MultiCare Health System's hospitals in Tacoma.

"We had a significant nursing vacancy and we were planning for our future as well," says Rita Wilson, who then led MultiCare's nurse-recruiting program. "Our nursing population is getting older. We had to do something so we'd have a steady stream coming in."

Nursing shortages are nothing new. Since World War II, the United States has experienced a nursing shortage every 10 years or so. But this one is different. It's expected to cut deeper and last longer because it's caused primarily by demographics rather than economics, says Linda Tieman, executive director of the Washington Center for Nursing, a private nonprofit focused on making sure Washington state has enough nurses.

Washington has 71,755 registered nurses - 5,160 short of what's needed. Looking ahead is even more alarming. If nothing is done, the state will be down 30,000 nurses by 2020, according to the Washington State Nurses Association.

Nationally, if trends continue, the country will be short 275,000 nurses by 2010. Federal estimates project the nation will need to train or recruit at least 800,000 nurses by 2020 to keep up with nurse retirements and a growing need as baby boomers age and require more medical care.

"The reality is that we aren't going to be able to do that," says Cheryl Peterson, senior policy analyst for the American Nurses Association. "What about funding for nursing education? Better working conditions?" she asks. How does the health-care system need to be reformed to make better use of staff it already has?

During an era of restructuring in the mid-1990s, Peterson says, staffing cuts and belt-tightening in the American heath-care industry drove away nurses who felt overworked and were worried about patient safety as well as their own. By 2005, about half a million registered nurses left the profession.

Consider: The average age of nurses in Washington state is 45. So the bulk of the state's nurses are in their 50s and likely to soon retire. They are the tail generation of American women for whom job options were severely limited.

"Nurses, teachers, secretaries. Those were the career options," recalls 59-year-old Tieman. "Women have unlimited choices now."

No surprise that there was a dip in nurse demographics as post-boomer women chose to become doctors or go into law, business, computers, marine science.

Yet plenty of Americans want to be nurses now, especially given improving salaries. (At Allenmore, for example, base salaries for registered nurses start at $42,000 a year, rising to $83,000 with 28 years' experience. The state average RN salary is $60,000. Nationally, agency and traveling nurses who work as "temps" can earn more than $110,000 annually, without benefits.)

These days, lack of interest isn't what's restricting the flow of nurse grads. The problem is that nursing schools don't have enough teachers. Last year, Washington state's 40 nursing programs turned away 45 percent of qualified applicants. Again, witness the baby-boom effect. The average age among the nursing faculty in Washington is 54. And given relatively low academic salaries, schools find it hard to compete for experienced nurses who want to retire or work in more lucrative industry jobs.

This year, the Center for Nursing raised about half a million dollars to expand the capacity of nursing schools and support training for nurses who want to become nursing educators. Tieman says health-care facilities and nursing schools are starting to talk about how to reform the system so more nurses can be trained. But it's too early to say how many more or how fast.

Meanwhile, across the country, as older nurses age out and burn out and students can't squeeze through the school bottleneck fast enough to replace them, foreign-educated nurses are increasingly filling the gap.

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