Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reinforcing teaching about home infection prevention with a client who is HIV positive. Which of the following statements by the client indicates an understanding of the teaching?
A. I will disinfect contaminated hard surfaces with a mixture of one part peroxide to 10 parts water.
B. I will place used sharp items in an empty cereal box for disposal.
C. I will put soiled dressings in a tied plastic bag before placing them in the trash.
Putting soiled dressings in a tied plastic bag before placing them in the trash reduces the risk of exposure to blood-borne pathogens for anyone who handles the trash.
D. I will use animal-skin condoms when having sex.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Comprehensive Predictor 2023 Proctored Exam. Take the full exam now
Full Explanation
The correct answer is C. Putting soiled dressings in a tied plastic bag before placing them in the trash reduces the risk of exposure to blood-borne pathogens for anyone who handles the trash.
Similar Questions
A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect?
A. Pressured speech
B. Catatonia
C. Memory loss that disrupts ADLS
Memory loss that disrupts activities of daily living (ADLs) is a common manifestation of dementia, which is a progressive decline in cognitive function. Pressured speech, catatonia, and illusions are more likely to be seen in clients who have psychotic disorders, such as schizophrenia or bipolar disorder.
D. Illusions
Full Explanation
The correct answer is C. Memory loss that disrupts activities of daily living (ADLs) is a common manifestation of dementia, which is a progressive decline in cognitive function. Pressured speech, catatonia, and illusions are more likely to be seen in clients who have psychotic disorders, such as schizophrenia or bipolar disorder.
A nurse is reinforcing teaching with a new parent about bathing her newborn. Which of the following statements should the nurse include?
A. "Ensure the bath water is at least 96 degrees Fahrenheit."
B. "Perform sponge baths until the baby's umbilical cord falls off."
Performing sponge baths until the baby's umbilical cord falls off is a recommended practice to prevent infection and promote healing of the cord stump. The bath water should be warm but not hot, around 85 to 90 degrees Fahrenheit. Talcum powder can irritate the baby's skin and lungs and should be avoided. Alkaline soap can dry out the baby's skin and should be replaced with a mild, pH-balanced cleanser.
C. "Apply talcum powder daily after bathing in order to prevent diaper rash."
D. "Use an alkaline soap to bathe the baby."
Full Explanation
The correct answer is B. Performing sponge baths until the baby's umbilical cord falls off is a recommended practice to prevent infection and promote healing of the cord stump. The bath water should be warm but not hot, around 85 to 90 degrees Fahrenheit. Talcum powder can irritate the baby's skin and lungs and should be avoided. Alkaline soap can dry out the baby's skin and should be replaced with a mild, pH-balanced cleanser.
A nurse is contributing to an in-service for newly licensed nurses about situations requiring an incident report. Which of the following examples should the nurse include?
A. A nurse discovers that a client's family member has administered a PCA dose.
While it is concerning that a client's family member administered a patient-controlled analgesia (PCA) dose, it is more appropriate to address this situation through immediate intervention, education, and communication with the healthcare provider. An incident report may not be necessary unless there are further complications or system issues related to this incident.
B. A nurse discovers that an electronic IV pump delivered twice the prescribed amount of fluid to a client.
An error in fluid administration by an IV pump, especially when it involves delivering twice the prescribed amount, is a medication error that could have serious consequences, such as fluid overload or electrolyte imbalances. An incident report must be filed to document the event and investigate what went wrong with the equipment.
C. A nurse observes another nurse remove wrist restraints one at a time from a client who is currently calm.
Removing wrist restraints one at a time, particularly when the client is calm, follows safe practice to prevent injury. This situation does not represent an error, violation, or adverse event, and does not require an incident report. Restraints should always be removed cautiously and gradually to ensure client safety.
D. A nurse observes a client vomiting after receiving an oral pain medication.
A client vomiting after receiving an oral pain medication could be an adverse drug reaction. While this is important to document in the patient’s medical record, it may not always require an incident report unless it leads to further complications or indicates a medication error.
E. None
None
F. None
None
Full Explanation
A. While it is concerning that a client's family member administered a patient-controlled analgesia (PCA) dose, it is more appropriate to address this situation through immediate intervention, education, and communication with the healthcare provider. An incident report may not be necessary unless there are further complications or system issues related to this incident.
B. An error in fluid administration by an IV pump, especially when it involves delivering twice the prescribed amount, is a medication error that could have serious consequences, such as fluid overload or electrolyte imbalances. An incident report must be filed to document the event and investigate what went wrong with the equipment.
C. Removing wrist restraints one at a time, particularly when the client is calm, follows safe practice to prevent injury. This situation does not represent an error, violation, or adverse event, and does not require an incident report. Restraints should always be removed cautiously and gradually to ensure client safety.
D. A client vomiting after receiving an oral pain medication could be an adverse drug reaction. While this is important to document in the patient’s medical record, it may not always require an incident report unless it leads to further complications or indicates a medication error.