Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is assisting with discharge teaching for a client who requires oropharyngeal suctioning at home. The nurse should ensure that which of the following equipment is available for use at home?
A. Oropharyngeal airway
This is incorrect because an Oropharyngeal airway is used to maintain or open the airway.
B. Water-soluble lubricant
This is incorrect because water-soluble lubricant is used for lubricating the suction catheter during suctioning.
C. Yankauer catheter
A Yankauer catheter is a suction device used for oral suctioning. It is important for this client to have access to a Yankauer catheter for safe and effective suctioning of secretions from the mouth.
D. Sterile gloves
This is incorrect because sterile gloves are not routinely needed for suctioning.
E. Sterile gloves
This question is an excerpt from Nurse Dive's nursing test bank - ATI PN Adult Med Surg 2020 with NGN Proctored Exam. Take the full exam now
Full Explanation
Yankauer catheter. A Yankauer catheter is a suction device used for oral suctioning. It is important for this client to have access to a Yankauer catheter for safe and effective suctioning of secretions from the mouth.
Option A is incorrect because an Oropharyngeal airway is used to maintain or open the airway.
Option B is incorrect because the water-soluble lubricant is used for lubricating the suction catheter during suctioning.
Option D is incorrect because sterile gloves are not routinely needed for suctioning.
Reasons why the other options are not answered: Option A: An oropharyngeal airway is not used for suctioning but is used to maintain an open airway in an unconscious patient. Option B: Water-soluble lubricant is used for lubricating the suction catheter during suctioning. Option D: Sterile gloves are not routinely needed for suctioning.
Similar Questions
A nurse is reinforcing teaching with a client who has anemia and has a prescription for ferrous sulfate. Which of the following foods should the nurse recommend that the client consume to increase the absorption of this medication?
A. Baked potatoes
Choice A, baked potatoes, is not the correct answer because it is not high in ascorbic acid.
B. Oatmeal
Choice B, oatmeal, is not the correct answer because it is not high in ascorbic acid. Choice D, cheese, is not the correct answer because it is not high in ascorbic acid.
C. Raw oranges
Oranges contain high levels of ascorbic acid, which can increase the absorption of ferrous sulfate. Baked potatoes, oatmeal, and cheese are not high in ascorbic acid and are not recommended to increase the absorption of ferrous sulfate.
D. Cheese
Choice D, cheese, is not the correct answer because it is not high in ascorbic acid.
Full Explanation
Oranges contain high levels of ascorbic acid, which can increase the absorption of ferrous sulfate. Baked potatoes, oatmeal, and cheese are not high in ascorbic acid and are not recommended to increase the absorption of ferrous sulfate.
Choice A, baked potatoes, is not the correct answer because it is not high in ascorbic acid.
Choice B, oatmeal, is not the correct answer because it is not high in ascorbic acid. Choice D, cheese, is not the correct answer because it is not high in ascorbic acid.
Which of the following symptoms should a nurse expect to find when assessing an infant who is dehydrated in an emergency department? Select all that apply
A. Tachycardia.
“Tachycardia” and “Irritability” are both symptoms that a nurse should expect to find when assessing an infant who is dehydrated in an emergency department. Dehydration occurs when an infant loses so much body fluid that they are not able to maintain ordinary function. Tachycardia, or a fast heart rate, is a common sign of dehydration in babies and toddlers. Irritability is also a common sign of dehydration in newborns.
B. Bloating.
Choice B is not an answer because bloating is not a common symptom of dehydration in infants.
C. Hypertension.
Choice C is not an answer because hypertension, or high blood pressure, is not a common symptom of dehydration in infants.
D. Irritability.
Irritability is asymptomthat a nurse should expect to find when assessing an infant who is dehydrated in an emergency department.
Full Explanation
The correct answer is Choice A, Choice D.
Choice A rationale: Tachycardia, or an increased heart rate, is a common symptom of dehydration in infants. The body attempts to maintain adequate blood circulation despite reduced fluid volume by increasing the heart rate, which is a compensatory mechanism.
Choice B rationale: Bloating is not typically associated with dehydration in infants. Dehydration usually results in symptoms like dry mucous membranes and decreased skin turgor, rather than gastrointestinal symptoms like bloating.
Choice C rationale: Hypertension, or high blood pressure, is uncommon in dehydrated infants. Dehydration generally leads to hypotension (low blood pressure) due to decreased fluid volume in the circulatory system, which can result in reduced blood pressure.
Choice D rationale: Irritability is a frequent symptom of dehydration in infants. Reduced fluid intake and electrolyte imbalances can cause discomfort and distress, leading to irritability and increased fussiness in dehydrated infants.
A nurse is collecting admission history data from a client who is in a semi-private room. Which of the following data is the priority for the nurse to address?
A. Recent exposure to tuberculosis
Recent exposure to tuberculosis. This is the priority data that the nurse should address as it puts other clients and hospital staff at risk of contracting tuberculosis
B. History of generalized anxiety disorder
This is not urgent and can be addressed after addressing option A. History of generalized anxiety disorder is not an urgent issue that requires the nurse's immediate attention
C. Reports periodic migraine headaches
This is not urgent and can be addressed after addressing option A. Reports periodic migraine headaches are not an urgent issue that requires the nurse's immediate attention.
D. Experiences nocturia
This is not urgent and can be addressed after addressing option A. Experiencing nocturia isnot an urgent issue that requires the nurse's immediate attention.
E. Experiences nocturia
Full Explanation
Recent exposure to tuberculosis. This is the priority data that the nurse should address as it puts other clients and hospital staff at risk of contracting tuberculosis. Options B, C, and D are not urgent and can be addressed after addressing option A.
Reasons why the other options are not answers:
Option B: A history of generalized anxiety disorder is not an urgent issue that requires the nurse's immediate attention.
Option C: Reports periodic migraine headaches are not an urgent issue that requires the nurse's immediate attention.
Option D: Experiencing nocturia is not an urgent issue that requires the nurse's immediate attention.