Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 67-year-old patient is admitted to the ICU following a myocardial infarction that has caused damage to the right side of the heart.
What complication is the patient most likely to experience?
A. Enlargement of the liver
Enlargement of the liver is not a common complication following a myocardial infarction that has caused damage to the right side of the heart.
B. Pulmonary congestion
Pulmonary congestion is more commonly associated with left-sided heart failure.
C. Cardiac Tamponade
Cardiac Tamponade is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. This can occur as a result of a myocardial infarction, but it is not the most likely complication in this scenario.
D. Peripheral edema
Peripheral edema is a common complication following a myocardial infarction that has caused damage to the right side of the heart. When the right side of the heart is damaged, it can lead to a backup of blood in the body’s veins, which can cause swelling in the ankles, legs, and abdomen.
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Full Explanation
Choice A rationale
Enlargement of the liver is not a common complication following a myocardial infarction that has caused damage to the right side of the heart.
Choice B rationale
Pulmonary congestion is more commonly associated with left-sided heart failure.
Choice C rationale
Cardiac Tamponade is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. This can occur as a result of a myocardial infarction, but it is not the most likely complication in this scenario.
Choice D rationale
Peripheral edema is a common complication following a myocardial infarction that has caused damage to the right side of the heart. When the right side of the heart is damaged, it can lead to a backup of blood in the body’s veins, which can cause swelling in the ankles, legs, and abdomen.
Similar Questions
The nurse is providing education to the staff about delirium.
Which statement made by a staff member indicates a need for further education?
A. “An infection’s resolution can reverse delirium.”.
An infection’s resolution can indeed reverse delirium. Delirium is often caused by a physical or mental illness, such as an infection.
B. “Delirium and dementia cannot coexist.”.
The statement “Delirium and dementia cannot coexist” is incorrect and indicates a need for further education. Delirium and dementia can coexist.
C. “Sleep deprivation can lead to delirium.”.
Sleep deprivation can lead to delirium. This is a correct statement and does not indicate a need for further education.
D. “Frequent reality orientation should be used with delirium.”.
Frequent reality orientation should be used with delirium. This is a correct statement and does not indicate a need for further education.
Full Explanation
Choice A rationale
An infection’s resolution can indeed reverse delirium. Delirium is often caused by a physical or mental illness, such as an infection.
Choice B rationale
The statement “Delirium and dementia cannot coexist” is incorrect and indicates a need for further education. Delirium and dementia can coexist.
Choice C rationale
Sleep deprivation can lead to delirium. This is a correct statement and does not indicate a need for further education.
Choice D rationale
Frequent reality orientation should be used with delirium. This is a correct statement and does not indicate a need for further education.
Who is recognized as the “mother of psychiatric nursing”?
A. Hildegard Peplau
Hildegard Peplau is recognized as the “mother of psychiatric nursing”67. She made significant contributions to nursing science, professional nursing, and psychiatric nursing through the development of the Interpersonal Relations paradigm.
B. Madeleine Leninger
Madeleine Leninger is known for her work on transcultural nursing, not psychiatric nursing.
C. Dorthea Orem
Dorthea Orem is known for her Self-Care Deficit Nursing Theory, not psychiatric nursing.
D. Jean Watson
Jean Watson is known for her Theory of Human Caring, not psychiatric nursing.
Full Explanation
Choice A rationale
Hildegard Peplau is recognized as the “mother of psychiatric nursing”67. She made significant contributions to nursing science, professional nursing, and psychiatric nursing through the development of the Interpersonal Relations paradigm.
Choice B rationale
Madeleine Leninger is known for her work on transcultural nursing, not psychiatric nursing.
Choice C rationale
Dorthea Orem is known for her Self-Care Deficit Nursing Theory, not psychiatric nursing.
Choice D rationale
Jean Watson is known for her Theory of Human Caring, not psychiatric nursing.
A nurse administers medication to a patient at 0900.
Seven hours later, the nurse realizes a medication error has occurred and completes an incident report. At what time, in 24-hour clock format, did the nurse complete the incident report?
A. 4 p.m.
B. 1600
The nurse completed the incident report at 1600. Step 1 is to understand the 24-hour clock format. In this format, the hours of the day run 0-23, midnight to midnight. Step 2 is to convert the time the nurse administered the medication (0900) to the 12-hour clock format. This is 9 a.m. Step 3 is to add seven hours to this time (the time that passed before the nurse realized a medication error had occurred). 9 a.m. + 7 hours = 4 p.m. Step 4 is to convert this time back to the 24-hour clock format. 4 p.m. is 1600 in the 24-hour clock format.
C. 1700
D. 7 p.m.
Full Explanation
The nurse completed the incident report at 1600.
Step 1 is to understand the 24-hour clock format. In this format, the hours of the day run 0-23, midnight to midnight.
Step 2 is to convert the time the nurse administered the medication (0900) to the 12-hour clock format. This is 9 a.m.
Step 3 is to add seven hours to this time (the time that passed before the nurse realized a medication error had occurred). 9 a.m. + 7 hours = 4 p.m.
Step 4 is to convert this time back to the 24-hour clock format. 4 p.m. is 1600 in the 24-hour clock format.