Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse determines that clients who receive zolpidem postoperatively have an increased fall rate compared to other postoperative clients. To which of the following members of the health care team should the nurse report these findings?
A. The surgeon
B. The case manager
C. The risk manager
Rationale: The risk manager is responsible for identifying and managing potential or actual sources of harm or loss in a healthcare organization. The risk manager would be interested in analyzing the data on zolpidem use and fall rate, implementing preventive measures, and reporting adverse events to regulatory agencies if needed. The surgeon may not be directly involved in prescribing zolpidem or monitoring its effects on postoperative clients. The case manager may not have access to or authority over medication administration policies or practices. The pharmacist may be able to provide information on zolpidem's pharmacokinetics and pharmacodynamics, but may not be able to address the organizational factors that contribute to fall risk.
D. The pharmacist
This question is an excerpt from Nurse Dive's nursing test bank - ATI Comprehensive Predictor 2023 Proctored Exam. Take the full exam now
Full Explanation
The correct answer is C. The risk manager.
Rationale: The risk manager is responsible for identifying and managing potential or actual sources of harm or loss in a healthcare organization. The risk manager would be interested in analyzing the data on zolpidem use and fall rate, implementing preventive measures, and reporting adverse events to regulatory agencies if needed. The surgeon may not be directly involved in prescribing zolpidem or monitoring its effects on postoperative clients. The case manager may not have access to or authority over medication administration policies or practices. The pharmacist may be able to provide information on zolpidem's pharmacokinetics and pharmacodynamics, but may not be able to address the organizational factors that contribute to fall risk.
Similar Questions
A nurse is preparing to perform a wet-to-dry dressing change for a client who has an infected abdominal wound. Which of the following techniques should the nurse use when performing this dressing change?
A. Clean the wound from the center to the outer edges.
Rationale: The nurse should clean the wound from the center to the outer edges to prevent contamination of the wound bed by bacteria or debris from the surrounding skin. The nurse should wear clean gloves, not sterile gloves, to remove the dressing, as wet-to-dry dressings are not sterile and do not require a sterile technique. The nurse should remove the tape by pulling parallel to and away from the skin, not from the center of the dressing, to minimize skin damage and pain. The nurse should not moisten the dressing before removal, as this would defeat the purpose of wet-to-dry dressings, which are intended to debride necrotic tissue by adhering to it and pulling it off when dry.
B. Wear sterile gloves to remove the dressing.
C. Remove the tape by pulling from the center of the dressing.
D. Moisten the dressing before removal.
Full Explanation
The correct answer is A. Clean the wound from the center to the outer edges.
Rationale: The nurse should clean the wound from the center to the outer edges to prevent contamination of the wound bed by bacteria or debris from the surrounding skin. The nurse should wear clean gloves, not sterile gloves, to remove the dressing, as wet-to-dry dressings are not sterile and do not require a sterile technique.
The nurse should remove the tape by pulling parallel to and away from the skin, not from the center of the dressing, to minimize skin damage and pain. The nurse should not moisten the dressing before removal, as this would defeat the purpose of wet-to-dry dressings, which are intended to debride necrotic tissue by adhering to it and pulling it off when dry.
A nurse is caring for a client who is postoperative following a subtotal thyroidectomy. The nurse should place the client in which of the following positions?
A. Left lateral
B. Dorsal recumbent
C. Supine
D. Semi-Fowler's
This position allows for optimal drainage of secretions and reduces edema and tension on the suture line. It also facilitates breathing and prevents aspiration. Left lateral, dorsal recumbent and supine positions can increase the risk of airway obstruction, bleeding and infection.
Full Explanation
The correct answer is D. Semi-Fowler's position. This position allows for optimal drainage of secretions and reduces edema and tension on the suture line. It also facilitates breathing and prevents aspiration. Left lateral, dorsal recumbent, and supine positions can increase the risk of airway obstruction, bleeding and infection.
A nurse is contributing to the plan of care for a client who has ascites due to cirrhosis. Which of the following interventions should the nurse recommend to include in the plan?
A. Position the client supine with legs elevated.
Positioning the client supine with legs elevated is not recommended for managing ascites. This position does not help in reducing fluid accumulation in the abdomen and may worsen respiratory issues.
B. Keep the client's daily protein intake below 0.8 g/kg.
Keeping the client’s daily protein intake below 0.8 g/kg is not typically recommended for clients with cirrhosis and ascites. Adequate protein intake is necessary to prevent muscle wasting and maintain nutritional status.
C. Restrict the client's sodium intake to 3 g per day.
Restricting the client’s sodium intake to 2 g not 3g per day is a common intervention for managing ascites, but it is usually more restrictive, often around 2 g per day, to effectively reduce fluid retention.
D. Measure the client's abdominal girth daily.
Measuring the client’s abdominal girth daily is essential for monitoring the progression of ascites. It helps in assessing the effectiveness of treatment and detecting any worsening of the condition.
Full Explanation
The correct answer is choice d. Measure the client’s abdominal girth daily.
Choice A rationale:
Positioning the client supine with legs elevated is not recommended for managing ascites. This position does not help in reducing fluid accumulation in the abdomen and may worsen respiratory issues.
Choice B rationale:
Keeping the client’s daily protein intake below 0.8 g/kg is not typically recommended for clients with cirrhosis and ascites. Adequate protein intake is necessary to prevent muscle wasting and maintain nutritional status.
Choice C rationale:
Restricting the client’s sodium intake to 2 g not 3g per day is a common intervention for managing ascites, but it is usually more restrictive, often around 2 g per day, to effectively reduce fluid retention.
Choice D rationale:
Measuring the client’s abdominal girth daily is essential for monitoring the progression of ascites. It helps in assessing the effectiveness of treatment and detecting any worsening of the condition.