Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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
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
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.
Similar Questions
A nurse is collecting data from a female client during an initial health assessment. Which of the following findings should the nurse identify as a risk factor for osteoporosis?
A. Applies an estrogen vaginal cream daily
Estrogen is important for maintaining bone health, and a decrease in estrogen levels after menopause is a risk factor for osteoporosis. Using estrogen vaginal cream can indicate that the client is postmenopausal and may have a decreased level of estrogen, which puts her at risk for osteoporosis. Canned sardines are a good source of calcium, walking is good for overall health, and a beclomethasone inhaler is used for respiratory issues and does not affect bone health.
B. Includes canned sardines in her diet
Canned sardines are actually a good source of calcium, which is important for bone health.
C. Walks 30 min per day
Walking 30 minutes per day is a weight-bearing exercise that helps maintain bone density and is beneficial for preventing osteoporosis.
D. Uses a beclomethasone inhaler
Using a beclomethasone inhaler (a corticosteroid) can be a risk factor for osteoporosis, especially if used long-term, as corticosteroids can lead to bone loss.
Full Explanation
Choice A rationale: Applying an estrogen vaginal cream daily is not a risk factor for osteoporosis. In fact, estrogen can help maintain bone density.
Choice B rationale: Including canned sardines in the diet provides calcium and vitamin D, which are beneficial for bone health.
Choice C rationale: Walking 30 minutes per day is a weight-bearing exercise that helps maintain bone density and is beneficial for preventing osteoporosis.
Choice D rationale: Using a beclomethasone inhaler (a corticosteroid) can be a risk factor for osteoporosis, especially if used long-term, as corticosteroids can lead to bone loss.
A nurse is collecting data from an older adult client. Which of the following findings should indicate to the nurse that the client has a bladder infection?
A. Temperature 37.3° C (99.1° F)
A temperature of 37.3° C (99.1° F) is within the normal range and does not necessarily indicate a bladder infection.
B. WBC Count 9,000/mm3
A WBC count of 9,000/mm3 is within the normal range and does not necessarily indicate a bladder infection.
C. Changed mental status
A bladder infection can lead to confusion or other changes in mental status, especially in older adults. A normal temperature and WBC count do not necessarily indicate a bladder infection. Diminished reflexes are not typically associated with a bladder infection.
D. Diminished reflexes
Diminished reflexes are not typically associated with a bladder infection.
Full Explanation
A bladder infection can lead to confusion or other changes in mental status, especially in older adults. A normal temperature and WBC count do not necessarily indicate a bladder infection. Diminished reflexes are not typically associated with a bladder infection.
A: A temperature of 37.3° C (99.1° F) is within the normal range and does not necessarily indicate a bladder infection.
B: A WBC count of 9,000/mm3 is within the normal range and does not necessarily indicate a bladder infection.
D: Diminished reflexes are not typically associated with a bladder infection.
A nurse is caring for a visually impaired client. What action should the nurse take when delivering the client's meal tray?
A. Arrange for an assistive personnel to feed the client.
Arrange for an assistive personnel to feed the client: Arranging for an assistive personnel to feed the client may take away the client's independence.
B. Discourage conversations during the client's mealtime.
Discourage conversations during the client's mealtime: Discouraging conversations during the client's mealtime may make the client feel isolated.
C. Provide the client with small-handled adaptive utensils.
Provide the client with small-handled adaptive utensils: Providing the client with small-handled adaptive utensils may not help the client locate food on the plate.
D. Describe the food placement as though the plate were a clock.
The correct answer is choice D, Describe the food placement as though the plate were a clock. When delivering the client's meal tray, the nurse should describe the food placement as though the plate were a clock to help the client know where the food is located. This helps the client be more independent and participate actively at mealtime. Choice A is incorrect because arranging for assistive personnel to feed the client may take away the client's independence. Choice B is incorrect because discouraging conversations during the client's mealtime may make the client feel isolated. Choice C is incorrect because providing the client with small-handled adaptive utensils may not help the client locate food on the plate. Other choices:
Full Explanation
The correct answer is choice D, Describe the food placement as though the plate were a clock. When delivering the client's meal tray, the nurse should describe the food placement as though the plate were a clock to help the client know where the food is located. This helps the client be more independent and participate actively at mealtime. Choice A is incorrect because arranging for assistive personnel to feed the client may take away the client's independence. Choice B is incorrect because discouraging conversations during the client's mealtime may make the client feel isolated. Choice C is incorrect because providing the client with small-handled adaptive utensils may not help the client locate food on the plate.
Other choices:
A. Arrange for assistive personnel to feed the client: Arranging for assistive personnel to feed the client may take away the client's independence.
B. Discourage conversations during the client's mealtime: Discouraging conversations during the client's mealtime may make the client feel isolated.
B. Provide the client with small-handled adaptive utensils: Providing the client with small-handled adaptive utensils may not help the client locate food on the plate.