Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who is 1 day postoperative following an appendectomy. Which of the following findings should the nurse report?
A. Temperature 37.2° C (99° F)
A temperature of 37.2°C (99°F) is within the normal range and does not require reporting.
B. Serosanguineous drainage at the incision site
Serosanguineous drainage at the incision site is normal within the first few days postoperatively.
C. Red streaks along the incision
Red streaks along the incision. This is a possible sign of infection and should be reported to the healthcare provider. A temperature of 37.2°C (99°F) is within the normal range and does not require reporting. Serosanguineous drainage at the incision site is normal within the first few days postoperatively. Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.
D. Hypoactive bowel sounds in all four quadrants
Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.
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
Red streaks along the incision. This is a possible sign of infection and should be reported to the healthcare provider. A temperature of 37.2°C (99°F) is within the normal range and does not require reporting. Serosanguineous drainage at the incision site is normal within the first few days postoperatively. Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.
Choice A: A temperature of 37.2°C (99°F) is within the normal range and does not require reporting.
Choice B: Serosanguineous drainage at the incision site is normal within the first few days postoperatively.
Choice D: Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.
Similar Questions
A nurse is reinforcing teaching with a client who is recovering from gastroenteritis and is beginning oral intake. Which of the following foods should the nurse recommend?
A. Orange juice
Orange juice is acidic and can irritate the stomach lining, which is not ideal for someone recovering from gastroenteritis. Acidic foods and drinks can exacerbate symptoms like nausea and stomach pain.
B. Cream of broccoli soup
Cream of broccoli soup is not recommended because it is a dairy-based product. Dairy can be difficult to digest and may worsen symptoms like diarrhea and stomach cramps during the recovery phase of gastroenteritis.
C. Lime ice popsicle
Lime ice popsicle is a good choice because it is a clear liquid that can help with hydration and is easy on the stomach. Ice popsicles can also help soothe the throat and provide a small amount of sugar for energy without overwhelming the digestive system.
D. Vanilla pudding
Vanilla pudding, although soft, contains dairy, which can be hard to digest for someone recovering from gastroenteritis. Dairy products can lead to further gastrointestinal discomfort.
Full Explanation
The correct answer is choice C. Lime ice popsicle.
Choice A rationale:
Orange juice is acidic and can irritate the stomach lining, which is not ideal for someone recovering from gastroenteritis. Acidic foods and drinks can exacerbate symptoms like nausea and stomach pain.
Choice B rationale:
Cream of broccoli soup is not recommended because it is a dairy-based product. Dairy can be difficult to digest and may worsen symptoms like diarrhea and stomach cramps during the recovery phase of gastroenteritis.
Choice C rationale:
Lime ice popsicle is a good choice because it is a clear liquid that can help with hydration and is easy on the stomach. Ice popsicles can also help soothe the throat and provide a small amount of sugar for energy without overwhelming the digestive system.
Choice D rationale:
Vanilla pudding, although soft, contains dairy, which can be hard to digest for someone recovering from gastroenteritis. Dairy products can lead to further gastrointestinal discomfort.
A nurse is contributing to the plan of care for a client who has disuse syndrome following cast removal from a lower extremity. Which of the following referrals should the nurse include in the plan of care?
A. Social worker
A social worker can help the client and their family with emotional and social issues related to the condition.
B. Herbalist
An herbalist is not necessary for the management of disuse syndrome.
C. Dietitian
A dietitian can help the client with their nutritional needs but may not address their physical functioning.
D. Occupational therapist
Disuse syndrome is a condition that occurs when a person experiences a reduction in physical activity, resulting in a decline in physical function. An occupational therapist can help the client improve their ability to perform daily activities and improve their overall functioning.
Full Explanation
Occupational therapist. Disuse syndrome is a condition that occurs when a person experiences a reduction in physical activity, resulting in a decline in physical function. An occupational therapist can help the client improve their ability to perform daily activities and improve their overall functioning. A social worker can help the client and their family with emotional and social issues related to the condition. An herbalist is not necessary for the management of disuse syndrome. A dietitian can help the client with their nutritional needs but may not address their physical functioning.
A nurse is reinforcing teaching with a client who has a BMI of 32 and wants to lose weight. Which of the following statements should the nurse make to promote the client's weight loss?
A. "Consume 500 fewer calories per day than your estimated calorie needs." B. "Plan your meals so up to 40 percent of your calories come from fats."
"Consume 500 fewer calories per day than your estimated calorie needs." Consuming slightly fewer calories than one's estimated calorie needs can help promote weight loss in a healthy and safe way. Planning meals so that up to 40% of calories come from fats is not typically recommended when trying to lose weight, as too much fat can lead to excess calorie intake. Refined grains should be avoided in favor of whole grains, and it is not recommended to reward oneself with special foods for achieving short-term goals.
B. "Include refined grains as a good carbohydrate in your diet."
Planning meals so that up to 40% of calories come from fat is not typically recommended when trying to lose weight, as too much fat can lead to excess calorie intake.
C. "Reward yourself with special foods for achieving short-term goals."
Refined grains should be avoided in favor of whole grains.
Full Explanation
"Consume 500 fewer calories per day than your estimated calorie needs." Consuming slightly fewer calories than one's estimated calorie needs can help promote weight loss in a healthy and safe way. Planning meals so that up to 40% of calories come from fats is not typically recommended when trying to lose weight, as too much fat can lead to excess calorie intake. Refined grains should be avoided in favor of whole grains, and it is not recommended to reward oneself with special foods for achieving short-term goals.
Choice B: Planning meals so that up to 40% of calories come from fat is not typically recommended when trying to lose weight, as too much fat can lead to excess calorie intake.
Choice C: Refined grains should be avoided in favor of whole grains.
Choice D: It is not recommended to reward oneself with special foods for achieving short-term goals.