The Journey to Becoming a Nurse

I hate it when I pick an answer and it's correct but I end up changing it because I think about it too much and convince myself that it's wrong.

Do you think it's easy to become a registered nurse with a Bachelor of Science in Nursing? Well, here's a math problem for you.

An intravenous piggyback (IVPB) of cefazolin 500 mg in 50 mL of 5% dextrose in water is to be administered over a 20-minute period. The tubing has a drop factor of 15 drops/mL. The nurse regulates the infusion to run at how many drops per minute? Record your answer using a whole number in gtts (drops)/min.

The answer is 38 gtts/min. How did I get that answer?

First, you need to find the infusion rate in milliliters (mL) per hour. To do this, multiply 50 mL by 3. If 50 mL is infused in 20 minutes, then 150 mL (50 x 3 because 20 min goes into 60 min 3 times) would infuse in an hour at the same rate.

Now, you can set up your equation. You need gtts/min, so to get to that, you need to multiply 150mL/1hr x 15gtts/1mL to get 2,250gtts/hr.

To get to gtts/min instead of gtts/hr, you need to convert hours to minutes by multiplying 2,250gtts/hr x 1hr/60min. This gives you the answer of 38 gtts/min (37.5 rounds up to 38).

"One of the deep secrets of life is that all that is really worth doing is what we do for others."
-Lewis Carol

I believe I have witnessed my first sentinel event last week. According to the New York State Office of Mental Health, a sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function.
Thankfully, no one died during this event. However, the amputation of an arm will most likely occur. What happened was that the patient experienced extravasation of their IV site. According to Alberta, "Extravasation is leakage of fluid in the tissues around the IV site. It happens when the IV catheter has come out of the blood vessel but is still in the nearby tissue. It may also happen if the blood vessel leaks because it is weak or damaged.
The fluids collect in the tissues around the IV site rather than staying in the blood vessel. The buildup of fluid can cause tissue damage at the site. The leakage also prevents the medicine or fluid from being sent into the bloodstream for treatment as intended."
The National Library of Medicine states that, "The damage can extend to involve nerves, tendons, and joints and can continue for months after the initial insult. If treatment is delayed, surgical debridement, skin grafting, and even amputation may be the unfortunate consequences of such an injury."
Below is a photo of a severe case of IV extravasation obtained from the New England Journal of Medicine.

References
MyHealth.Alberta.ca
National Library of Medicine
New England Journal of Medicine
New York State Office of Mental Health

I worked with a primarily Spanish-speaking patient the other day. The first thing I said to the patient was, "Hola! Mi español es MUY malo! Lo siento!" (Hello! My Spanish is VERY bad! I'm sorry!) 🤣 They just chuckled. We did not have a professional translator at the time (we really should have, it's vital for positive patient outcomes) and they got a little frustrated throughout the day because I couldn't understand many of their requests, but we managed!

NCLEX-RN Practice Question of the Day

While providing discharge instructions to a client with systemic lupus erythematosus (SLE), the nurse includes which information?

Select all that apply.

A. "Monitor your temperature."
B. "Get adequate rest."
C. "Take corticosteroid doses as needed."
D. "Exercise intensely three times per week."
E. "Wear sunblock."

What do you think? Put your answer in the comments section! The answer can be found below!

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Answer:
A. "Monitor your temperature."
B. "Get adequate rest."
E. "Wear sunblock."

Rationale:
SLE is an autoimmune disease that can affect almost any organ. The nurse plans care to promote satisfactory pain management, maximum symptom management, avoidance of activities that exacerbate the disease, and optimal role function and self-image. Clients should be taught about medication actions, side effects, and dosage; they should also be taught energy conservation and avoidance of physical and emotional stress. Pain relief measures, protection from sun damage, and regular medical follow-up should be included in client teaching.

Correct answer:
A. "Monitor your temperature."
Persons with SLE have an increased risk of infection, so fever should be reported to the health care provider.

Correct answer:
B. "Get adequate rest."
Persons with SLE have persistent fatigue and should ensure they have adequate sleep, including naps if needed.

Incorrect answer:
C. "Take corticosteroid doses as needed."
Oral corticosteroids should be taken regularly as prescribed and not stopped abruptly.

Incorrect answer:
D. "Exercise intensely three times per week."
Intense exercise may cause fatigue and increase muscle pain.

Correct answer:
E. "Wear sunblock."
Ultraviolet light can exacerbate symptoms, leading to a flare-up. Sunblock and covering the extremities can help.

NCLEX-RN Practice Question

Which of the following correctly describes the relationship between cells and tissues?

A. Each individual cell is alive, and tissues are made of dead cells.
B. Tissues are groups of cells that are similar in structure and function.
C. Cells are composed of specialized tissues called organelles.
D. Tissues produce the chemical energy that cells need to survive and grow.

What do you think? Let me know in the comments section! The answer and rationale are below!

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Answer:
B. Tissues are groups of cells that are similar in structure and function.

Rationale:
Cells are the structural and functional units of the human body and the building blocks of all living things. A tissue is a group of cells with a similar structure that function together as a unit. Collectively, cells and tissues carry out chemical activities that sustain life.

Incorrect answer:
A. Each individual cell is alive, and tissues are made of dead cells.
Tissues are made almost entirely of living cells. In healthy tissue, cells that die are replaced.

Correct answer:
B. Tissues are groups of cells that are similar in structure and function.
This is correct.

Incorrect answer:
C. Cells are composed of specialized tissues called organelles.
Cells do contain organelles, but organelles are not made of tissues. Tissues are made of cells.

Incorrect answer:
D. Tissues produce the chemical energy that cells need to survive and grow.
Cells produce the chemical energy that tissues need to survive and grow.

NCLEX-RN Practice Question

I got this one right!

A client receives a prescription for va**nal medication to be administered via an applicator. The nurse takes which action during administration?

A. Declines the client's request to self-administer the medication
B. Inserts the applicator tip into the va**na for administration
C. Uses a sterile glove to administer the medication
D. Asks the client to lay supine for ten minutes after administration

What do you think the answer is? Put your answer in the comments section! The answer and rationale can be found below.

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Answer:
D. Asks the client to lay supine for ten minutes after administration

Rationale:
Vaginal administration of medication may be done in the form of jellies, foam, sprays, cream, or suppositories. Suppositories are often prone to melting and are stored in the refrigerator. Once it is inserted into the va**nal cavity, the body temperature causes it to melt and absorb. Jellies and creams are given via an applicator. Regardless of the medication form, Standard Precautions should be followed, as an infection is often the reason va**nal medications are needed.

Incorrect answer:
A. Declines the client's request to self-administer the medication
Clients often may prefer to self-administer va**nal medications due to the nature of administration. With proper teaching, the nurse may let the client do so.

Incorrect answer:
B. Inserts the applicator tip into the va**na for administration
The applicator should be inserted about two to three inches to ensure the medication is sufficiently placed within the va**na.

Incorrect answer:
C. Uses a sterile glove to administer the medication
Sterile gloves are not necessary because the va**na is not a sterile environment. Clean gloves should be worn, and Standard Precautions should be followed because va**nal administration of medications is usually prescribed because of an infection.

Correct answer:
D. Asks the client to lay supine for ten minutes after administration
After administration, the client should remain on their back for at least ten minutes to allow the medication to be distributed and absorbed evenly and not be lost in the or***ce.

NCLEX-RN Practice Question

I got this one right!

The nurse cares for a client receiving pembrolizumab for metastatic melanoma. The nurse is concerned about immune-mediated hyperthyroidism when assessing which findings?

A. The client's weight is up 10 lb (4.5 kg) and the client reports constipation.
B. The client's total cholesterol is 230 mg/dL and the client reports joint pain.
C. The client's respiratory rate is 11 breaths/min and the client reports a depressed mood.
D. The client's heart rate is 110 beats/min and the client reports frequent anxiety.

What do you think the answer is? Put your answer in the comments section! The answer and rationale can be found below.

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Answer:
D. The client's heart rate is 110 beats/min and the client reports frequent anxiety.

Rationale:
Immunotherapy is a type of cancer treatment that helps the body's immune system fight cancer cells. Pembrolizumab is an immunotherapy drug in the antineoplastic therapeutic class and the monoclonal antibody pharmacologic class.

Pembrolizumab is a humanized monoclonal antibody that reverses T cell suppression, which results in decreased tumor growth. Adverse effects include immune-mediated reactions, such as pneumonitis, colitis, thyroid disorders, hepatitis, endocrine disorders, and arthritis.

Incorrect answer:
A. The client's weight is up 10 lb (4.5 kg) and the client reports constipation.
Weight gain and constipation are signs and symptoms of hypothyroidism.

Incorrect answer:
B. The client's total cholesterol is 230 mg/dL and the client reports joint pain.
Elevated cholesterol levels and pain, stiffness, or swelling in the joints are signs and symptoms of hypothyroidism.

Incorrect answer:
C. The client's respiratory rate is 11 breaths/min and the client reports of depressed mood.
Bradypnea and depressed mood are signs and symptoms of hypothyroidism.

Correct answer:
D. The client's heart rate is 110 beats/min and the client reports frequent anxiety.
Tachycardia and anxiety are signs and symptoms of hyperthyroidism. This may concern the nurse about an immune-mediated reaction.

NCLEX-RN Practice Question

I didn't know this one!

Which of the following correctly matches the part of the gastrointestinal system with an important enzyme it produces?

A. Small intestine - Lipase
B. Pancreas - Trypsin
C. Stomach - Amylase
D. Mouth - Lactase

What do you think the answer is? Post it in the comments section! The answer can be found below, as well as a rationale.

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Answer:
B. Pancreas - Trypsin

Rationale:
In the gastrointestinal system, organs and glands produce distinct enzymes to chemically digest different substances. The liver produces bile, which is a blend of bile salts, bilirubin, fats, and inorganic salts. None of these are enzymes, but bile is an important component of breaking down fats into fatty acids in the small intestine.

Incorrect answer:
A. Small intestine - Lipase
The small intestine produces so-called brush border enzymes, such as proteases, lactase, and disaccharidases, but it does not produce lipase.

Correct answer:
B. Pancreas - Trypsin
This is correct.

I chose this incorrect answer:
C. Stomach - Amylase
The stomach produces gastric lipase and pepsinogen (a precursor to pepsin) but not amylase.

Incorrect answer:
D. Mouth - Lactase
The saliva of the mouth contains amylase and lipase but not lactase.

NCLEX-RN Practice Question

The nurse provides care to an older school-age client with a fractured wrist. After teaching the client's family about cast care, which parental statement indicates a need for additional teaching?

A. "I will make sure that we keep the cast elevated on a pillow for at least one day."
B. "I will be sure to expose the plaster cast to air to allow it to dry completely."
C. "I should encourage my child to move the shoulder and elbow joints."
D. "I should expect my child's fingers to be swollen and change color."

What do you think the answer is? Put your answer in the comments section! The answer and rationale can be found below.

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Answer:
D. "I should expect my child's fingers to be swollen and change color."

Rationale:
Bone fractures occur when the resistance of bone against the stress being exerted yields to the stress force. Fractures are a common injury at any age but are more likely to occur in children and older adults. Because childhood is a time of rapid bone growth, the pattern of fractures, problems of diagnosis, and methods of treatment differ in children compared with adults.

In children, fractures heal much faster than in adults. Consequently, children may not require as long a period of immobilization of the affected extremity as an adult with a fracture.

Appropriate cast care guidelines for the child's caregiver are necessary before discharge. Instructions are also given for checking for signs and symptoms that indicate that the cast is too tight. Parents should also be told to take the child to the healthcare provider for attention if the cast becomes too loose because a loose cast no longer serves its purpose.

A. "I will make sure that we keep the cast elevated on a pillow for at least one day."
The cast should be elevated on a pillow for at least 24 hours after its application. This will decrease edema that can cause issues with circulation; therefore, this statement indicates a correct understanding of the information presented by the nurse.

B. "I will be sure to expose the plaster cast to air to allow it to dry completely."
Plaster casts must be exposed to air to allow for complete drying after application; therefore, this statement indicates a correct understanding of the information presented by the nurse.

I picked this answer, which is incorrect.
C. "I should encourage my child to move the shoulder and elbow joints."
It is appropriate to exercise the joints above and below the fracture; therefore, this statement indicates a correct understanding of the information presented by the nurse.

This is the correct answer.
D. "I should expect my child's fingers to be swollen and change color."
Edema and color changes to the fingers could be indicative of impaired circulation and should be reported to the healthcare provider immediately; therefore, this statement indicates a need for additional teaching from the nurse.

NCLEX-RN Practice Question

Cardiac cells have an abundance of __________ to meet the energy production demands of the cell.

A. Mitochondria
B. Nuclei
C. Lysosomes
D. Rough endoplasmic reticulum (Rough ER)

What do you think the answer is? Comment below! You'll also find the answer in the comments section.

The Journey to Becoming a Nurse updated their business hours.

Fun Nursing/Healthcare Fact:

In pediatrics, there's a procedure called a "clean out." This is performed on patients who are severely constipated. First, a nasogastric tube, or NG tube, is inserted through the patient's nose and into the stomach. Then, an IV is inserted to ensure the patient stays hydrated throughout the procedure. The nurses then put on a gown because the next step is...messy. Basically, a tube is temporarily inserted into the re**um. Water is then inserted through the tube and into the re**um. The water is then removed, and along with it, stool. This is repeated a few times and generally occurs every four hours until the water removed from the re**um is clear. This procedure helps to remove any impactions and also stimulates bowel movements. Note that this procedure is usually reserved for patients who have not had a bowel movement in a prolonged period of time (e.g., a few months). Below is a picture of an NG tube. If you have any questions, I'd love to answer them in the comments.

References:
https://www.gillettechildrens.org/your-visit/patient-education/using-a-nasogastric-tube

Nursing school is the hardest thing I've ever done in my life, and many nurses would say the same thing.

Healthy 18-year-old Illinois girl dies of COVID-19: 'You need to take it seriously'

Can you remember a time that a nurse made you feel better about your condition or a loved one's? Tell us your story in the comments!

All immunogens are antigens, but not all antigens are immunogens.

The badge I got for clinicals has my student ID picture on it, which was taken three years ago. I'm 100% embarassed and I'm trying to get a new one with a more recent photo. Even my professor was confused. He was like, "This picture is so different! You didn't have any hair and now you're wearing glasses!" My face was BRIGHT RED with embarrassment. 😅😂

EVERYBODY hates inflammation. It hurts, it can cause swelling, and it's usually not very pleasant. However, without inflammation, we likely wouldn't survive! Inflammation protects your body by killing any germs that may enter your body through an injury, like a cut. Here's a surprising fact: You probably have three or four inflammatory responses happening in your body right now, and you don't even know it! Our bodies are almost always using inflammation to keep us healthy and alive. Share if you learned something new!

Photo URL:
https://mend.me/how-your-diet-can-impact-inflammation-and-healing/

Currently listening to Pokémon music remixes while studying how to assess the cardiovascular system. 💓