Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has HIV and is neutropenic. Which of the following findings should the nurse identify as increasing the risk for the client to develop an infection?
A. The client has artificial flowers in the room.
Artificial flowers are generally considered safer than fresh flowers because they do not harbor water, which can be a source of bacterial growth. However, they can collect dust, which might carry pathogens, though this is typically a lesser concern compared to fresh flowers.
B. The client is assigned to a room with negative airflow.
Being assigned to a room with negative airflow is actually beneficial for a client with an immunocompromised condition, as it helps prevent the spread of airborne pathogens.
C. The client's meal tray contains hard boiled eggs
Hard boiled eggs do not inherently increase the risk of infection. However, it is important to ensure that all food items are properly prepared, handled, and stored to minimize the risk of foodborne illnesses.
D. The client's meal tray includes ice cream with fresh fruit.
Fresh fruit can harbor bacteria and other pathogens on their surfaces, which can pose a significant risk to a neutropenic patient. Even with thorough washing, there is a higher risk compared to cooked or pasteurized foods.
This question is an excerpt from Nurse Dive's nursing test bank - ATI PN Comprehensive Predictor 2023 - Proctored Exam 1. Take the full exam now
Full Explanation
Correct answer: D
a. Artificial flowers are generally considered safer than fresh flowers because they do not harbor water, which can be a source of bacterial growth. However, they can collect dust, which might carry pathogens, though this is typically a lesser concern compared to fresh flowers.
b. Being assigned to a room with negative airflow is actually beneficial for a client with an immunocompromised condition, as it helps prevent the spread of airborne pathogens.
c. Hard boiled eggs do not inherently increase the risk of infection. However, it is important to ensure that all food items are properly prepared, handled, and stored to minimize the risk of foodborne illnesses.
d. Fresh fruit can harbor bacteria and other pathogens on their surfaces, which can pose a significant risk to a neutropenic patient. Even with thorough washing, there is a higher risk compared to cooked or pasteurized foods.
Similar Questions
A nurse is reinforcing teaching to a newly licensed nurse about bowel sounds. Which of the following characteristics should the nurse use to describe hyperactive bowel sounds?
A. No sounds heard after listening for 3 to 5 min
B. Can be a result of an early bowel obstruction
C. Sounds are soft and at a rate of 1/min
D. Indicates decreased motility
Full Explanation
The nurse should describe hyperactive bowel sounds as sounds that are loud, high-pitched, and increased in frequency and intensity. They are more frequent than the normal bowel sounds, with a rapid succession of sounds occurring at a rate greater than 5 to 30 sounds per minute.
Hyperactive bowel sounds can be heard in conditions such as gastroenteritis, diarrhea, and early mechanical bowel obstruction. They indicate increased bowel motility and are often associated with increased peristalsis.
To differentiate hyperactive bowel sounds from normal or hypoactive bowel sounds, the nurse can explain that hypoactive bowel sounds are decreased or absent sounds that occur when the bowel motility is decreased, such as in conditions like paralytic ileus or after abdominal surgery. Normal bowel sounds are typically soft, low-pitched, and occur at a rate of 5 to 30 sounds per minute.
A nurse on a medical-surgical unit is caring for a group of clients. Which of the following clients should the nurse see first?
A. A client who is postoperative and reports intermittent nausea
The client who is postoperative and reports intermittent nausea can be assessed and managed after addressing the client with the elevated blood pressure and headache.
B. A client whose blood pressure is 160/90 mm Hg and reports a headache
Hypertensive crisis is a severe increase in blood pressure that can lead to organ damage or other complications. Prompt assessment and intervention are necessary to prevent further escalation of blood pressure and potential complications. While all the clients mentioned require attention, the client with elevated blood pressure and a headache poses a higher immediate risk. The nurse should assess the client's blood pressure, evaluate for signs of target organ damage, and initiate appropriate interventions, which may include administering antihypertensive medications as prescribed and monitoring closely for any changes in the client's condition.
C. A client who is scheduled for surgery in 2 hr
The client scheduled for surgery in 2 hours can be addressed according to the scheduled timeline.
D. A client who is postoperative and has a Jackson-Pratt drain
The client who is postoperative and has a Jackson-Pratt drain should be assessed and managed, but their condition does not require immediate intervention compared to the client with the elevated blood pressure and headache.
Full Explanation
Hypertensive crisis is a severe increase in blood pressure that can lead to organ damage or other complications. Prompt assessment and intervention are necessary to prevent further escalation of blood pressure and potential complications.
While all the clients mentioned require attention, the client with elevated blood pressure and a headache poses a higher immediate risk. The nurse should assess the client's blood pressure, evaluate for signs of target organ damage, and initiate appropriate interventions, which may include administering antihypertensive medications as prescribed and monitoring closely for any changes in the client's condition.
The client who is postoperative and reports intermittent nausea can be assessed and managed after addressing the client with the elevated blood pressure and headache.
The client scheduled for surgery in 2 hours can be addressed according to the scheduled timeline.
A nurse is assisting in developing a list of internet sites for clients to obtain valid health information. When evaluating internet resources, which of the following findings indicates the information likely contains credible medical information?
A. The author's name is listed without credentials.
The author's name listed without credentials does not provide information about the author's expertise or qualifications. It is important to assess the author's credentials and expertise to determine their credibility.
B. The author cites references to statements made.
Valid and reliable health information sources should provide references or citations to support the information they present. This demonstrates that the information is based on evidence and has been reviewed by experts in the field. It allows readers to verify the accuracy and reliability of the information by referring to the cited sources.
C. The website URL is listed as .com.
The website URL being listed as .com does not provide information about the accuracy or reliability of the content. Different types of websites, such as .org or .gov, can also contain credible health information.
D. The website was last updated 3 years ago.
The website being last updated 3 years ago raises concerns about the currency and relevance of the information. Health information can quickly evolve, and it is important to access up-to-date resources.
Full Explanation
Valid and reliable health information sources should provide references or citations to support the information they present. This demonstrates that the information is based on evidence and has been reviewed by experts in the field. It allows readers to verify the accuracy and reliability of the information by referring to the cited sources.
The author's name listed without credentials does not provide information about the author's expertise or qualifications. It is important to assess the author's credentials and expertise to determine their credibility.
The website URL being listed as .com does not provide information about the accuracy or reliability of the content. Different types of websites, such as .org or .gov, can also contain credible health information.
The website being last updated 3 years ago raises concerns about the currency and relevance of the information. Health information can quickly evolve, and it is important to access up-to-date resources.