Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has a temperature of 38.7° C (101.7° F). Which of the following nursing interventions is appropriate?
A. Keep the client's bed linens dry.
Keeping the client's bed linens dry helps maintain the client's comfort and prevents chilling associated with damp linens.
B. Apply an alcohol-water solution to the client's skin.
Applying an alcohol-water solution may increase evaporative cooling and is not a standard intervention for fever.
C. Encourage the client to drink 1,500 mL of fluid per day.
Encouraging increased fluid intake is appropriate to promote hydration, but the specific amount should be individualized based on the client's condition and needs.
D. Apply ice packs to the groin.
Applying ice packs to the groin is not a recommended site for cooling and may cause discomfort. The choice of cooling measures should be appropriate and based on the healthcare provider's orders or institutional protocols.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Rn Fundamentals Proctored Exam 6. Take the full exam now
Full Explanation
A. Keeping the client's bed linens dry helps maintain the client's comfort and prevents chilling associated with damp linens.
B. Applying an alcohol-water solution may increase evaporative cooling and is not a standard intervention for fever.
C. Encouraging increased fluid intake is appropriate to promote hydration, but the specific amount should be individualized based on the client's condition and needs.
D. Applying ice packs to the groin is not a recommended site for cooling and may cause discomfort. The choice of cooling measures should be appropriate and based on the healthcare provider's orders or institutional protocols.
Similar Questions
42. A nurse is providing teaching to a client who uses tobacco products. (Move the steps that the nurse should take into the box on the right, placing them in the correct order of performance. All steps must be used.)
A. Teach the client cessation strategies.
B. Develop a cessation plan with the client.
C. Assist the client in modifying the plan if necessary.
D. Ask about the type of tobacco product used.
Full Explanation
Correct order: D A B C
D. Ask about the type of tobacco product used.
A. Teach the client cessation strategies.
B. Develop a cessation plan with the client.
C. Assist the client in modifying the plan if necessary.
A parish nurse is developing a program of educational sessions to meet the needs of the older adults in the congregation. Which of the following is the best approach to enhance development of suitable programs?
A. Survey the target population to determine topics of interest related to health issues.
Surveying the target population helps identify specific interests and health concerns, ensuring that the programs are tailored to the needs of older adults.
B. Determine availability of health care providers from the community to provide the presentations.
Determining the availability of health care providers is important but may not directly address the specific interests or concerns of the older adults.
C. Base the programs on their developmental stage emphasizing changes in function and physical capabilities.
Basing the programs on their developmental stage is important, but surveying the population allows for a more comprehensive understanding of their diverse needs and preferences.
D. Review the Healthy People 2020 Objectives to identify health issues affecting older adults.
Reviewing Healthy People 2020 Objectives is a valuable resource but may not capture the specific interests or concerns of the local population.
Full Explanation
A. Surveying the target population helps identify specific interests and health concerns, ensuring that the programs are tailored to the needs of older adults.
B. Determining the availability of health care providers is important but may not directly address the specific interests or concerns of the older adults.
C. Basing the programs on their developmental stage is important, but surveying the population allows for a more comprehensive understanding of their diverse needs and preferences.
D. Reviewing Healthy People 2020 Objectives is a valuable resource but may not capture the specific interests or concerns of the local population.
A nurse is teaching a client how to self-administer daily low-dose heparin injections. Which of the following factors is most likely to increase the client's motivation to learn?
A. The client's belief that his needs will be met through education
The client's belief that his needs will be met through education reflects intrinsic motivation, which is likely to enhance the client's commitment to learning and self-care.
B. The client seeking family approval by agreeing to a teaching plan
Seeking family approval may be a motivator, but it is an external factor, and intrinsic motivation is generally more effective for sustained behavior change.
C. The nurse explaining the need for education to the client
While the nurse explaining the need for education is important, the client's personal belief and understanding of the value of education are key for motivation.
D. The nurse's empathy about the client having to self-inject
The nurse's empathy is essential for building rapport, but the client's belief in the benefits of education is more directly related to motivation.
Full Explanation
A. The client's belief that his needs will be met through education reflects intrinsic motivation, which is likely to enhance the client's commitment to learning and self-care.
B. Seeking family approval may be a motivator, but it is an external factor, and intrinsic motivation is generally more effective for sustained behavior change.
C. While the nurse explaining the need for education is important, the client's personal belief and understanding of the value of education are key for motivation.
D. The nurse's empathy is essential for building rapport, but the client's belief in the benefits of education is more directly related to motivation.