Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is evaluating a client's understanding of their new prescription for albuterol inhaler. Which of the following actions by the client demonstrates correct use of the inhaler?
A. The client shakes the inhaler well before use.
Correct. The client should shake the inhaler well before use to mix the medication and propellant evenly and ensure proper dosage delivery.
B. The client holds their breath for 5 seconds after inhaling.
Incorrect. The client should hold their breath for 10 seconds after inhaling to allow the medication to reach the lower airways and improve bronchodilation.
C. The client exhales fully before placing the mouthpiece in their mouth.
Incorrect. The client should exhale fully after placing the mouthpiece in their mouth and closing their lips around it. This can prevent wasting of medication and ensure optimal inhalation.
D. The client repeats the puff after 15 seconds if needed.
Incorrect. The client should repeat the puff after 1 minute if needed or prescribed. Waiting for 1 minute between puffs can allow enough time for the first puff to take effect and reduce adverse effects such as tachycardia or tremors.
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Full Explanation
A) Correct. The client should shake the inhaler well before use to mix the medication and propellant evenly and ensure proper dosage delivery.
B) Incorrect. The client should hold their breath for 10 seconds after inhaling to allow the medication to reach the lower airways and improve bronchodilation.
C) Incorrect. The client should exhale fully after placing the mouthpiece in their mouth and closing their lips around it. This can prevent wasting of medication and ensure optimal inhalation.
D) Incorrect. The client should repeat the puff after 1 minute if needed or prescribed. Waiting for 1 minute between puffs can allow enough time for the first puff to take effect and reduce adverse effects such as tachycardia or tremors.
Similar Questions
A nurse is planning to teach a client who has hypertension about lifestyle modifications to lower their blood pressure. Which of the following topics should the nurse include in the teaching? (Select all that apply.)
A. Reducing sodium intake to less than 2 g per day.
Correct. The nurse should include reducing sodium intake to less than 2 g per day in the teaching. Sodium can increase fluid retention and blood volume, which can raise blood pressure.
B. Increasing physical activity to at least 30 minutes per day.
Correct. The nurse should include increasing physical activity to at least 30 minutes per day in the teaching. Physical activity can lower blood pressure by strengthening the heart, improving blood circulation, and reducing body weight.
C. Limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women.
Correct. Limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women. Excessive alcohol consumption can raise blood pressure, so moderation is important.
D. Quitting smoking and avoiding exposure to secondhand smoke.
Correct. Quitting smoking and avoiding exposure to secondhand smoke. Smoking and exposure to secondhand smoke are significant risk factors for hypertension and other cardiovascular diseases.
E. Taking a nap for 20 minutes every afternoon.
Incorrect. Taking a nap for 20 minutes every afternoon. While rest and relaxation are important for overall well-being, taking a nap specifically for 20 minutes every afternoon may not be directly related to lowering blood pressure. It's better to focus on the other lifestyle modifications mentioned above.
Full Explanation
A) Correct. The nurse should include reducing sodium intake to less than 2 g per day in the teaching. Sodium can increase fluid retention and blood volume, which can raise blood pressure.
B) Correct. The nurse should include increasing physical activity to at least 30 minutes per day in the teaching. Physical activity can lower blood pressure by strengthening the heart, improving blood circulation, and reducing body weight.
C) Correct. Limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women. Excessive alcohol consumption can raise blood pressure, so moderation is important.
D) Correct. Quitting smoking and avoiding exposure to secondhand smoke. Smoking and exposure to secondhand smoke are significant risk factors for hypertension and other cardiovascular diseases.
E) Incorrect. Taking a nap for 20 minutes every afternoon. While rest and relaxation are important for overall well-being, taking a nap specifically for 20 minutes every afternoon may not be directly related to lowering blood pressure. It's better to focus on the other lifestyle modifications mentioned above.
A nurse is teaching a client who has diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include in the teaching?
A. "Store unopened insulin vials in the freezer."
Incorrect. The nurse should instruct the client to store unopened insulin vials in the refrigerator, not in the freezer. Freezing can damage the insulin and make it ineffective.
B. "Rotate injection sites within the same anatomical region."
Correct. The nurse should instruct the client to rotate injection sites within the same anatomical region, such as the abdomen, thighs, arms, or buttocks. Rotating injection sites can prevent lipodystrophy, which is a disorder of fat metabolism that causes hypertrophy or atrophy of subcutaneous tissue.
C. "Mix short-acting and long-acting insulins in the same syringe."
Incorrect. The nurse should instruct the client not to mix short-acting and long-acting insulins in the same syringe. Mixing different types of insulins can alter their onset, peak, and duration of action and affect blood glucose control.
D. "Draw up regular insulin before NPH insulin when mixing them."
Correct. The nurse should instruct the client to draw up regular insulin before NPH insulin when mixing them in the same syringe. This can prevent contamination of the regular insulin vial with NPH insulin, which can affect its potency and clarity.
Full Explanation
A) Incorrect. The nurse should instruct the client to store unopened insulin vials in the refrigerator, not in the freezer. Freezing can damage the insulin and make it ineffective.
B) Correct. The nurse should instruct the client to rotate injection sites within the same anatomical region, such as the abdomen, thighs, arms, or buttocks. Rotating injection sites can prevent lipodystrophy, which is a disorder of fat metabolism that causes hypertrophy or atrophy of subcutaneous tissue.
C) Incorrect. The nurse should instruct the client not to mix short-acting and long-acting insulins in the same syringe. Mixing different types of insulins can alter their onset, peak, and duration of action and affect blood glucose control.
D) Correct. The nurse should instruct the client to draw up regular insulin before NPH insulin when mixing them in the same syringe. This can prevent contamination of the regular insulin vial with NPH insulin, which can affect its potency and clarity.
A nurse is caring for a client who is receiving intravenous (IV) antibiotics for a severe infection. The nurse observes that the IV site is red, swollen, and painful. Which of the following actions should the nurse take? (Select all that apply.)
A. Discontinue the IV line and start a new one in another site.
Correct. The nurse should discontinue the IV line and start a new one in another site. The IV site is showing signs of phlebitis, which is inflammation of the vein caused by mechanical, chemical, or bacterial irritation. Phlebitis can lead to complications such as thrombophlebitis, infection, or extravasation.
B. Apply a warm compress to the IV site.
Correct. The nurse should apply a warm compress to the IV site to promote vasodilation and blood flow, which can help reduce inflammation and pain.
C. Elevate the affected extremity on a pillow.
Correct. The nurse should elevate the affected extremity on a pillow to facilitate venous return and decrease edema.
D. Administer an antihistamine to the client.
Incorrect. The nurse should not administer an antihistamine to the client unless prescribed by the health care provider. Antihistamines are used to treat allergic reactions, not phlebitis.
E. Flush the IV line with normal saline.
Incorrect. The nurse should not flush the IV line with normal saline. Flushing the IV line can worsen the inflammation and increase the risk of infection or thrombus formation.
Full Explanation
A) Correct. The nurse should discontinue the IV line and start a new one in another site. The IV site is showing signs of phlebitis, which is inflammation of the vein caused by mechanical, chemical, or bacterial irritation. Phlebitis can lead to complications such as thrombophlebitis, infection, or extravasation.
B) Correct. The nurse should apply a warm compress to the IV site to promote vasodilation and blood flow, which can help reduce inflammation and pain.
C) Correct. The nurse should elevate the affected extremity on a pillow to facilitate venous return and decrease edema.
D) Incorrect. The nurse should not administer an antihistamine to the client unless prescribed by the health care provider. Antihistamines are used to treat allergic reactions, not phlebitis.
E) Incorrect. The nurse should not flush the IV line with normal saline. Flushing the IV line can worsen the inflammation and increase the risk of infection or thrombus formation.