Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is providing care to a client who has a history of asthma. The client presents with influenza symptoms that started the previous day. The provider orders an influenza test and prescribes an oral antiviral with instructions to begin the treatment as soon as possible. The client asks the nurse whether they can take the antiviral before the lab results are back. Which of the following responses by the nurse is appropriate?
A. "No, you should wait for lab confirmation because taking antivirals for a nonviral infection can increase side effects."
"No, you should wait for lab confirmation because taking antivirals for a nonviral infection can increase side effects.": While unnecessary use of antivirals can lead to side effects, prompt treatment in high-risk individuals (such as those with asthma) is crucial to mitigate complications, making this response less appropriate.
B. "No, you should wait for lab confirmation before beginning antiviral treatment, to prevent resistant viruses."
"No, you should wait for lab confirmation before beginning antiviral treatment, to prevent resistant viruses.": Delaying treatment in high-risk populations is not recommended as antivirals are most effective early in the course of the illness. This statement does not consider the urgency of treating influenza in vulnerable clients.
C. "Yes, antiviral treatment will ensure that you are less contagious and do not spread influenza to others."
"Yes, antiviral treatment will ensure that you are less contagious and do not spread influenza to others.": While antivirals can reduce viral shedding, this response overlooks the critical importance of early treatment in reducing the severity of the illness and preventing complications.
D. "Yes, antiviral treatments are most effective when they are started within 48 hours of symptom onset."
"Yes, antiviral treatments are most effective when they are started within 48 hours of symptom onset.": Antivirals are most effective when initiated within 48 hours of the onset of influenza symptoms, especially in individuals with underlying conditions like asthma. Starting treatment early can reduce the severity and duration of symptoms, making this the most appropriate response.
This question is an excerpt from Nurse Dive's nursing test bank - Ati lpn ut1 med surg proctored exam. Take the full exam now
Full Explanation
A. "No, you should wait for lab confirmation because taking antivirals for a nonviral infection can increase side effects.": While unnecessary use of antivirals can lead to side effects, prompt treatment in high-risk individuals (such as those with asthma) is crucial to mitigate complications, making this response less appropriate.
B. "No, you should wait for lab confirmation before beginning antiviral treatment, to prevent resistant viruses.": Delaying treatment in high-risk populations is not recommended as antivirals are most effective early in the course of the illness. This statement does not consider the urgency of treating influenza in vulnerable clients.
C. "Yes, antiviral treatment will ensure that you are less contagious and do not spread influenza to others.": While antivirals can reduce viral shedding, this response overlooks the critical importance of early treatment in reducing the severity of the illness and preventing complications.
D. "Yes, antiviral treatments are most effective when they are started within 48 hours of symptom onset.": Antivirals are most effective when initiated within 48 hours of the onset of influenza symptoms, especially in individuals with underlying conditions like asthma. Starting treatment early can reduce the severity and duration of symptoms, making this the most appropriate response.
Similar Questions
A nurse is providing care to a client who reports facial pain, including dental pain in the upper teeth. Which of the following additional symptoms would lead the nurse to suspect sinusitis as the source of the pain?
A. The client is producing large amounts of clear, watery nasal discharge and experiencing postnasal drip.
The client is producing large amounts of clear, watery nasal discharge and experiencing postnasal drip: Clear, watery nasal discharge is more indicative of allergic rhinitis rather than sinusitis, which typically presents with thicker, purulent discharge.
B. The client has a history of both tension and vascular headaches and takes prescription migraine medication as needed.
The client has a history of both tension and vascular headaches and takes prescription migraine medication as needed: While headaches can accompany sinusitis, this option does not directly address symptoms specific to sinusitis, such as nasal congestion or facial pressure.
C. The client has nasal congestion that does not significantly improve with over-the-counter decongestants or antihistamines.
The client has nasal congestion that does not significantly improve with over-the-counter decongestants or antihistamines: Persistent nasal congestion despite the use of decongestants or antihistamines is a common symptom of sinusitis, indicating that the source of the problem may be inflammation or infection in the sinuses.
D. The client regularly uses saline-based nasal washes and a humidifier to clean and moisturize their sinuses.
The client regularly uses saline-based nasal washes and a humidifier to clean and moisturize their sinuses: Regular use of these measures suggests the client is taking preventive care of their sinuses but does not necessarily indicate sinusitis.
Full Explanation
A. The client is producing large amounts of clear, watery nasal discharge and experiencing postnasal drip: Clear, watery nasal discharge is more indicative of allergic rhinitis rather than sinusitis, which typically presents with thicker, purulent discharge.
B. The client has a history of both tension and vascular headaches and takes prescription migraine medication as needed: While headaches can accompany sinusitis, this option does not directly address symptoms specific to sinusitis, such as nasal congestion or facial pressure.
C. The client has nasal congestion that does not significantly improve with over-the-counter decongestants or antihistamines: Persistent nasal congestion despite the use of decongestants or antihistamines is a common symptom of sinusitis, indicating that the source of the problem may be inflammation or infection in the sinuses.
D. The client regularly uses saline-based nasal washes and a humidifier to clean and moisturize their sinuses: Regular use of these measures suggests the client is taking preventive care of their sinuses but does not necessarily indicate sinusitis.
A nurse is caring for several clients on a medical-surgical unit. Which of the following clients have an elevated risk for hypocalcemia?
A. (Select All that Apply.)
The client who has renal failure: Renal failure can lead to hypocalcemia due to the kidneys' reduced ability to convert vitamin D to its active form, leading to decreased calcium absorption.
B. The client who has renal failure
The client who is postoperative following a thyroidectomy: Hypocalcemia can occur after thyroidectomy if the parathyroid glands are inadvertently damaged or removed, as they regulate calcium levels.
C. The client who is postoperative following a thyroidectomy
The client who has hyperparathyroidism: Hyperparathyroidism typically leads to hypercalcemia, not hypocalcemia, as excessive parathyroid hormone (PTH) increases calcium levels in the blood.
D. The client who has hyperparathyroidism
The client who has vitamin D deficiency: Vitamin D is essential for calcium absorption in the intestines, so a deficiency can lead to hypocalcemia.
E. The client who has vitamin D deficiency
The client who is receiving bisphosphonate medications: Bisphosphonates inhibit bone resorption, which can lead to a decrease in calcium levels, potentially causing hypocalcemia.
F. The client who is receiving bisphosphonate medications
The client who has Addison's disease: Addison's disease is primarily associated with electrolyte imbalances like hyponatremia and hyperkalemia, not hypocalcemia.
Full Explanation
A. The client who has renal failure: Renal failure can lead to hypocalcemia due to the kidneys' reduced ability to convert vitamin D to its active form, leading to decreased calcium absorption.
B. The client who is postoperative following a thyroidectomy: Hypocalcemia can occur after thyroidectomy if the parathyroid glands are inadvertently damaged or removed, as they regulate calcium levels.
C. The client who has hyperparathyroidism: Hyperparathyroidism typically leads to hypercalcemia, not hypocalcemia, as excessive parathyroid hormone (PTH) increases calcium levels in the blood.
D. The client who has vitamin D deficiency: Vitamin D is essential for calcium absorption in the intestines, so a deficiency can lead to hypocalcemia.
E. The client who is receiving bisphosphonate medications: Bisphosphonates inhibit bone resorption, which can lead to a decrease in calcium levels, potentially causing hypocalcemia.
F. The client who has Addison's disease: Addison's disease is primarily associated with electrolyte imbalances like hyponatremia and hyperkalemia, not hypocalcemia.
A nurse is collecting data on a client who has pneumonia. Which of the following findings should the nurse expect?
A. Hypothermia
Hypothermia: Pneumonia typically presents with fever rather than hypothermia. Fever is a common response to infection and inflammation.
B. Bradycardia
Bradycardia: Pneumonia usually causes tachycardia rather than bradycardia. Tachycardia is a compensatory response to improve oxygen delivery to tissues.
C. Pulse deficit
Pulse deficit: A pulse deficit is not a common finding in pneumonia. It is more associated with conditions like atrial fibrillation.
D. Tachypnea
Tachypnea: Tachypnea, or rapid breathing, is a common sign of pneumonia. It reflects the body’s attempt to improve oxygenation and compensate for impaired gas exchange.
Full Explanation
A. Hypothermia: Pneumonia typically presents with fever rather than hypothermia. Fever is a common response to infection and inflammation.
B. Bradycardia: Pneumonia usually causes tachycardia rather than bradycardia. Tachycardia is a compensatory response to improve oxygen delivery to tissues.
C. Pulse deficit: A pulse deficit is not a common finding in pneumonia. It is more associated with conditions like atrial fibrillation.
D. Tachypnea: Tachypnea, or rapid breathing, is a common sign of pneumonia. It reflects the body’s attempt to improve oxygenation and compensate for impaired gas exchange.