Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is contributing to the plan of care for a client who had a total joint replacement and is two days postoperative. Which of the following resources should the nurse consult to determine the client’s activity level for the day?
A. Critical pathway
Critical pathway provides a specific, timeline-based plan of care with expected outcomes and interventions, including activity levels.
B. Standards of care
Standards of care are important but may not offer specific guidance for the individual client's daily activity level.
C. Clinical practice guidelines
Guidelines may provide general recommendations but may lack specificity.
D. Textbook reference
This is general information source but not as specific or current as the institution's critical pathway.
This question is an excerpt from Nurse Dive's nursing test bank - Dumund ATI comprehensive med surg proctored exam. Take the full exam now
Full Explanation
A. Critical pathway provides a specific, timeline-based plan of care with expected outcomes and interventions, including activity levels.
B. Standards of care are important but may not offer specific guidance for the individual client's daily activity level.
C. Guidelines may provide general recommendations but may lack specificity.
D. This is general information source but not as specific or current as the institution's critical pathway.
Similar Questions
A nurse is reinforcing teaching with a client who has rheumatoid arthritis. Which of the following statements by the client indicates understanding of the information?
A. I will schedule important tasks in the afternoon.
Scheduling important tasks in the afternoon is a good strategy for managing fatigue, it does not directly address pain relief.
B. I need to perform range-of-motion of my joints if I notice they are red.
Performing range-of-motion if joints are red may exacerbate inflammation and is not a recommended practice.
C. I should stop exercising if 1 experience any discomfort.
Stopping exercising if experiencing discomfort is essential to differentiate between normal discomfort and pain that may indicate potential harm. Continuing with mild discomfort may be appropriate.
D. I can use heat or cold to help relieve my pain
Both heat and cold applications can provide relief from rheumatoid arthritis pain and inflammation.
Full Explanation
A. Scheduling important tasks in the afternoon is a good strategy for managing fatigue, it does not directly address pain relief.
B. Performing range-of-motion if joints are red may exacerbate inflammation and is not a recommended practice.
C. Stopping exercising if experiencing discomfort is essential to differentiate between normal discomfort and pain that may indicate potential harm. Continuing with mild discomfort may be appropriate.
D. Both heat and cold applications can provide relief from rheumatoid arthritis pain and inflammation.
A nurse is preparing to administer immunizations to a patient who has an allergy to eggs. The nurse should know that an allergy to eggs is a contraindication for which of the following immunizations?
A. Influenza (TIV)
Influenza vaccines are typically produced using eggs, and individuals with egg allergies may react to the vaccine. However, there are egg-free alternatives available, and consultation with an allergist is recommended in such cases.
B. Inactivated poliovirus (IPV)
Polio vaccines do not contain egg proteins and are safe for individuals with egg allergies.
C. Haemophilus influenza type b (Hib)
Hib vaccines are not contraindicated for individuals with egg allergies.
D. Hepatitis B (Hep B)
Hepatitis B vaccines do not contain egg proteins and are generally safe for individuals with egg allergies.
Full Explanation
A. Influenza vaccines are typically produced using eggs, and individuals with egg allergies may react to the vaccine. However, there are egg-free alternatives available, and consultation with an allergist is recommended in such cases.
B. Polio vaccines do not contain egg proteins and are safe for individuals with egg allergies.=
C. Hib vaccines are not contraindicated for individuals with egg allergies.
D. Hepatitis B vaccines do not contain egg proteins and are generally safe for individuals with egg allergies.
A nurse is caring for a client who experiences anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?
A. Albuterol
The first-line treatment for anaphylactic shock is epinephrine, as it rapidly reverses the severe manifestations of an allergic reaction.
B. Hydrocortisone sodium succinate
Albuterol is a bronchodilator and may help with respiratory symptoms but is not the first-line treatment for anaphylaxis.
C. Diphenhydramine
Steroids like hydrocortisone may be used in conjunction with epinephrine but are not the immediate first choice.
D. Epinephrine
Diphenhydramine may be used to manage symptoms but is not as rapidly effective as epinephrine.
Full Explanation
A. The first-line treatment for anaphylactic shock is epinephrine, as it rapidly reverses the severe manifestations of an allergic reaction.
B. Albuterol is a bronchodilator and may help with respiratory symptoms but is not the first-line treatment for anaphylaxis.
C. Steroids like hydrocortisone may be used in conjunction with epinephrine but are not the immediate first choice.
D. Diphenhydramine may be used to manage symptoms but is not as rapidly effective as epinephrine.