Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is planning care for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following manifestations is most appropriate for the nurse to monitor?
A. Elevated WBC
Elevated WBC is not typically associated with ITP, which primarily affects platelet counts.
B. Fever
Fever may indicate infection but is not specific to ITP.
C. Fatigue
Fatigue can occur in clients with ITP due to anemia or chronic illness but is not specific to the condition.
D. Ecchymosis
Ecchymosis (bruising) is a hallmark manifestation of ITP due to low platelet counts and increased bleeding tendencies.
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Full Explanation
A. Elevated WBC is not typically associated with ITP, which primarily affects platelet counts.
B. Fever may indicate infection but is not specific to ITP.
C. Fatigue can occur in clients with ITP due to anemia or chronic illness but is not specific to the condition.
D. Ecchymosis (bruising) is a hallmark manifestation of ITP due to low platelet counts and increased bleeding tendencies.
Similar Questions
A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as?
A. Fidelity
Fidelity refers to faithfulness and keeping promises made to clients.
B. Autonomy
Autonomy respects a client's right to make their own decisions about their care.
C. Nonmaleficence
Nonmaleficence is a core principle in healthcare ethics and emphasizes the primary duty of healthcare providers to do no harm to their clients. This means carefully considering the potential risks and benefits of any treatment or intervention before administering it.
D. Justice
Justice ensures fair and equitable access to care for all individuals.
Full Explanation
A. Fidelity refers to faithfulness and keeping promises made to clients.
B. Autonomy respects a client's right to make their own decisions about their care.
C. Nonmaleficence is a core principle in healthcare ethics and emphasizes the primary duty of healthcare providers to do no harm to their clients. This means carefully considering the potential risks and benefits of any treatment or intervention before administering it.
D. Justice ensures fair and equitable access to care for all individuals.
A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching?
A. Avoid crowds.
Neutropenic clients have reduced immune function and are at increased risk of infection from exposure to crowds and potential pathogens.
B. Take temperature weekly.
Taking temperatures daily, not weekly, is important to monitor for signs of infection in neutropenic clients.
C. Perform mild exercise, such as gardening.
Mild exercise is generally encouraged but should be discussed with the healthcare provider to ensure safety and infection prevention.
D. Eat plenty of fresh fruits and vegetables.
Fresh fruits and vegetables are important for overall nutrition but should be washed thoroughly to reduce the risk of infection.
Full Explanation
A. Neutropenic clients have reduced immune function and are at increased risk of infection from exposure to crowds and potential pathogens.
B. Taking temperatures daily, not weekly, is important to monitor for signs of infection in neutropenic clients.
C. Mild exercise is generally encouraged but should be discussed with the healthcare provider to ensure safety and infection prevention.
D. Fresh fruits and vegetables are important for overall nutrition but should be washed thoroughly to reduce the risk of infection.
A nurse is reviewing the medical record of a client who is to receive the first dose of cefoxitin via intermittent IV bolus. Which of the following findings should the nurse identify as a contraindication for the client to receive cefoxitin and report to the provider?
A. Serum creatinine 0.8 mg/dL
A serum creatinine level of 0.8 mg/dL is within the normal range and does not contraindicate the administration of cefoxitin.
B. A severe allergy to amoxicillin
A severe allergy to amoxicillin indicates a potential cross-allergy with cephalosporins like cefoxitin, making it a contraindication for administration.
C. A recent history of diarrhea for 3 days
A recent history of diarrhea is not typically a contraindication for administering cefoxitin, unless it is severe or related to a specific infectious cause.
D. A history of phlebitis following an IV infusion of 0.9% sodium chloride with 10 mEq of potassium chloride
A history of phlebitis from a previous IV infusion is not a contraindication for cefoxitin unless it suggests an intolerance to certain infusion components.
Full Explanation
A. A serum creatinine level of 0.8 mg/dL is within the normal range and does not contraindicate the administration of cefoxitin.
B. A severe allergy to amoxicillin indicates a potential cross-allergy with cephalosporins like cefoxitin, making it a contraindication for administration.
C. A recent history of diarrhea is not typically a contraindication for administering cefoxitin, unless it is severe or related to a specific infectious cause.
D. A history of phlebitis from a previous IV infusion is not a contraindication for cefoxitin unless it suggests an intolerance to certain infusion components.