Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who reports an area of redness, warmth, tenderness, and pain in the right calf.
The nurse anticipates which of the following orders when notifying the provider of this finding?
A. Obtain impedance plethysmography.
Impedance plethysmography is a test that uses electrical signals to measure blood flow and can be used to detect deep vein thrombosis (DVT). However, it is not the first-line diagnostic tool for DVT.
B. Apply cold therapy to the affected leg.
Cold therapy can help reduce inflammation and pain, but it is not a diagnostic measure for DVT.
C. Obtain a venous duplex ultrasound.
Venous duplex ultrasound is the most common test used to diagnose DVT. It uses sound waves to create pictures of the blood flowing through the veins in the leg.
D. Monitor Homan's sign.
Homan’s sign is a physical examination finding that was traditionally used to diagnose DVT, but it is not reliable or specific.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Med Surg Custom Proctored Exam 2. Take the full exam now
Full Explanation
Choice A rationale:
Impedance plethysmography is a test that uses electrical signals to measure blood flow and can be used to detect deep vein thrombosis (DVT). However, it is not the first-line diagnostic tool for DVT.
Choice B rationale:
Cold therapy can help reduce inflammation and pain, but it is not a diagnostic measure for DVT.
Choice C rationale:
Venous duplex ultrasound is the most common test used to diagnose DVT. It uses sound waves to create pictures of the blood flowing through the veins in the leg.
Choice D rationale:
Homan’s sign is a physical examination finding that was traditionally used to diagnose DVT, but it is not reliable or specific.
Similar Questions
A nurse is assessing a client who has fluid overload.
Which of the following findings should the nurse expect? (Select all that apply.).
A. Increased heart rate.
Increased heart rate is a compensatory mechanism to maintain cardiac output in the presence of fluid overload.
B. Increased respiratory rate.
Increased respiratory rate may occur due to pulmonary congestion caused by fluid overload.
C. Increased temperature.
Increased temperature is not typically associated with fluid overload.
D. Increased hematocrit.
Increased hematocrit would indicate dehydration, not fluid overload.
E. Increased blood pressure.
Increased blood pressure can occur due to increased blood volume in fluid overload.
Full Explanation
Choice A rationale:
Increased heart rate is a compensatory mechanism to maintain cardiac output in the presence of fluid overload.
Choice B rationale:
Increased respiratory rate may occur due to pulmonary congestion caused by fluid overload.
Choice C rationale:
Increased temperature is not typically associated with fluid overload.
Choice D rationale:
Increased hematocrit would indicate dehydration, not fluid overload.
Choice E rationale:
Increased blood pressure can occur due to increased blood volume in fluid overload.
A nurse prepares to replace the nearly empty container of total parenteral nutrition (TPN) for a client when she finds that there has been a delay in receiving the new container of solution from the pharmacy.
Which of the following solutions should the nurse infuse until the next container of TPN solution becomes available?
A. Dextrose 10% in water.
Dextrose 10% in water can be used as a temporary replacement for TPN to prevent hypoglycemia until the TPN solution is available.
B. 3% sodium chloride.
3% sodium chloride is a hypertonic solution and is not typically used as a replacement for TPN.
C. 0.9% sodium chloride.
0.9% sodium chloride, or normal saline, does not provide the necessary nutrients that are included in TPN.
D. Lactated Ringer's. .
Lactated Ringer’s is used for fluid resuscitation and does not provide the necessary nutrients that are included in TPN.
Full Explanation
Choice A rationale:
Dextrose 10% in water can be used as a temporary replacement for TPN to prevent hypoglycemia until the TPN solution is available.
Choice B rationale:
3% sodium chloride is a hypertonic solution and is not typically used as a replacement for TPN.
Choice C rationale:
0.9% sodium chloride, or normal saline, does not provide the necessary nutrients that are included in TPN.
Choice D rationale:
Lactated Ringer’s is used for fluid resuscitation and does not provide the necessary nutrients that are included in TPN.
A nurse is caring for a client who is undergoing a lumbar puncture.
Which of the following is the priority action for the nurse to take to maintain privacy for the client?
A. Pull the curtains around the client's bed.
Pulling the curtains around the client’s bed ensures privacy during the procedure.
B. Ask family members to leave the room.
Asking family members to leave the room might be necessary, but it’s not the priority action.
C. Use sterile drapes to cover the client.
Using sterile drapes to cover the client is important for maintaining sterility, not privacy.
D. Close the door to the client's room.
Closing the door to the client’s room can provide privacy, but pulling the curtains around the bed is a more immediate action.
Full Explanation
Choice A rationale:
Pulling the curtains around the client’s bed ensures privacy during the procedure.
Choice B rationale:
Asking family members to leave the room might be necessary, but it’s not the priority action.
Choice C rationale:
Using sterile drapes to cover the client is important for maintaining sterility, not privacy.
Choice D rationale:
Closing the door to the client’s room can provide privacy, but pulling the curtains around the bed is a more immediate action.