Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reinforcing teaching with a client who requires a bladder-training program for urinary incontinence.
Which of the following instructions should the nurse include in the teaching?
A. “Record your urination times for 24 hours before beginning the program.”
Keeping a voiding diary can help assess patterns, but it is not the primary instruction when reinforcing an active bladder-training schedule.
B. “Drink 4 liters of fluid between 6:00 a.m. and 8:00 p.m.”
Drinking 4 liters of fluid is excessive and can worsen urinary frequency and urgency.
C. “Void every 2 hours while awake.”
Voiding every 2 hours while awake is a standard initial bladder-training strategy. It establishes a scheduled pattern and helps prevent episodes of incontinence, with intervals gradually increased as control improves.
D. “Eliminate caffeine from your diet.”
Eliminating caffeine helps reduce bladder irritation, but it is an adjunct lifestyle modification rather than the core bladder-training technique.
E. None
None
F. None
None
This question is an excerpt from Nurse Dive's nursing test bank - ATI PN Capstone Proctored Comprehensive Assessment 2020 B. Take the full exam now
Full Explanation
A. Keeping a voiding diary can help assess patterns, but it is not the primary instruction when reinforcing an active bladder-training schedule.
B. Drinking 4 liters of fluid is excessive and can worsen urinary frequency and urgency.
C. Voiding every 2 hours while awake is a standard initial bladder-training strategy. It establishes a scheduled pattern and helps prevent episodes of incontinence, with intervals gradually increased as control improves.
D. Eliminating caffeine helps reduce bladder irritation, but it is an adjunct lifestyle modification rather than the core bladder-training technique.
Similar Questions
A nurse is contributing to the plan of care for a newly admitted client who has bipolar disorder and is experiencing mania.
Which of the following interventions should the nurse recommend?
A. Offer the client fluids high in fiber and protein every hour.
Offer the client fluids high in fiber and protein every hour. This is because clients who have bipolar disorder and are experiencing mania are at risk of dehydration, malnutrition, and weight loss due to increased activity, poor intake, and impaired judgment. Fluids high in fiber and protein can help prevent constipation and promote satiety.
B. Monitor the client’s vital signs twice per day.
Choice B is wrong because monitoring the client’s vital signs twice per day is not enough for a client who has mania. The nurse should monitor the client’s vital signs more frequently, at least every 4 hours, to assess for signs of dehydration, infection, or cardiac complications.
C. Encourage the client to participate in group therapy activities each day.
Choice C is wrong because encouraging the client to participate in group therapy activities each day can increase the client’s stimulation and agitation. The nurse should provide a calming environment with fewer stimuli and solitary activities for a client who has mania.
D. Weigh the client three times per week.
Choice D is wrong because weighing the client three times per week is not sufficient for a client who has mania. The nurse should weigh the client daily to monitor for weight loss and fluid imbalance.
Full Explanation
Offer the client fluids high in fiber and protein every hour. This is because clients who have bipolar disorder and are experiencing mania are at risk of dehydration, malnutrition, and weight loss due to increased activity, poor intake, and impaired judgment. Fluids high in fiber and protein can help prevent constipation and promote satiety.
Choice B is wrong because monitoring the client’s vital signs twice per day is not enough for a client who has mania. The nurse should monitor the client’s vital signs more frequently, at least every 4 hours, to assess for signs of dehydration, infection, or cardiac complications.
Choice C is wrong because encouraging the client to participate in group therapy activities each day can increase the client’s stimulation and agitation. The nurse should provide a calming environment with fewer stimuli and solitary activities for a client who has mania.
Choice D is wrong because weighing the client three times per week is not sufficient for a client who has mania. The nurse should weigh the client daily to monitor for weight loss and fluid imbalance.
A nurse is reinforcing teaching with a client who has gestational diabetes mellitus.
Which of the following statements by the client indicates an understanding of the teaching?
A. “My baby will be monitored for hypoglycemia after birth.”
This statement indicates an understanding of the teaching because babies born to mothers with gestational diabetes mellitus (GDM) are at risk for low blood sugar (hypoglycemia) after birth due to high insulin levels.
B. “I will check my blood glucose once every 8 hours.”
Choice B is wrong because a client who has GDM should check their blood glucose more frequently than once every 8 hours. The American Diabetes Association recommends checking blood glucose levels before meals and one hour after the start of each meal.
C. “My baby is at risk for being underweight at birth.”
Choice C is wrong because a baby born to a mother with GDM is at risk for being overweight (macrosomia) at birth, not underweight. This can lead to complications such as shoulder dystocia, birth trauma, and cesarean delivery.
D. “I should ensure that only 5 percent of my daily calories come from protein sources.”
Choice D is wrong because a client who has GDM should ensure that about 15 to 20 percent of their daily calories come from protein sources, not 5 percent. Protein helps regulate blood glucose levels and supports fetal growth.
Full Explanation
This statement indicates an understanding of the teaching because babies born to mothers with gestational diabetes mellitus (GDM) are at risk for low blood sugar (hypoglycemia) after birth due to high insulin levels.
Choice B is wrong because a client who has GDM should check their blood glucose more frequently than once every 8 hours. The American Diabetes Association recommends checking blood glucose levels before meals and one hour after the start of each meal.
Choice C is wrong because a baby born to a mother with GDM is at risk for being overweight (macrosomia) at birth, not underweight. This can lead to complications such as shoulder dystocia, birth trauma, and cesarean delivery.
Choice D is wrong because a client who has GDM should ensure that about 15 to 20 percent of their daily calories come from protein sources, not 5 percent. Protein helps regulate blood glucose levels and supports fetal growth.
The LPN is discussing childbirth classes with a patient who is 30 weeks gestation. The patient shares that she hopes to deliver a baby who is awake and alert. The LPN is aware of Lamaze and Bradley classes being offered. For which reasons would the LPN recommend Bradley classes to this patient? Select all that apply.
A. The Bradley method teaches the labor partner how to coach and support the mother during labor.
The Bradley method teaches the labor partner how to coach and support the mother during labor. This is true because the Bradley method emphasizes the role of the partner as an active participant and a skilled coach who can help the mother relax, breathe, and cope with pain during labor. The partner also serves as an advocate for the mother's preferences and needs in the hospital setting.
B. The Bradley method teaches the mother and partner about the variety of methods to control pain.
The Bradley method teaches the mother and partner about the variety of methods to control pain. This is false because the Bradley method does not teach a variety of methods to control pain, but rather focuses on relaxation as the main way to reduce pain during labor. The Bradley method also discourages the use of medication or medical interventions for pain relief, unless they are medically necessary.
C. The Bradley method prepares the woman to deliver without medical interventions and medications.
The Bradley method prepares the woman to deliver without medical interventions and medications. This is true because the Bradley method aims to help women have an unmedicated birth with minimal medical intervention. The Bradley method teaches women how to avoid unnecessary interventions and how to cope with natural labor by using relaxation, breathing, nutrition, and exercise. The Bradley method also educates women on how to reduce their risk of having a C-section and what to do if it becomes medically necessary.
D. The Bradley method focuses on muscle control because muscle tension increases the pain of labor.
The Bradley method focuses on muscle control because muscle tension increases the pain of labor. This is false because the Bradley method does not focus on muscle control, but rather on deep and complete relaxation during labor. The Bradley method believes that muscle tension interferes with the natural process of labor and increases pain, so it teaches women how to relax their muscles and let their body do the work.
E. The Bradley method is the most widely used method in the US.
The Bradley method is the most widely used method in the US. This is false because the Bradley method is not the most widely used method in the US, but rather one of several options for natural childbirth. According to a 2017 survey by Listening to Mothers, only 4% of women reported using the Bradley method for their most recent birth, compared to 48% who used Lamaze, 14% who used hypnobirthing, and 9% who used other methods.
Full Explanation
Choice A reason:
The Bradley method teaches the labor partner how to coach and support the mother during labor. This is true because the Bradley method emphasizes the role of the partner as an active participant and a skilled coach who can help the mother relax, breathe, and cope with pain during labor. The partner also serves as an advocate for the mother's preferences and needs in the hospital setting.
Choice B reason:
The Bradley method teaches the mother and partner about the variety of methods to control pain. This is false because the Bradley method does not teach a variety of methods to control pain, but rather focuses on relaxation as the main way to reduce pain during labor. The Bradley method also discourages the use of medication or medical interventions for pain relief, unless they are medically necessary.
Choice C reason:
The Bradley method prepares the woman to deliver without medical interventions and medications. This is true because the Bradley method aims to help women have an unmedicated birth with minimal medical intervention. The Bradley method teaches women how to avoid unnecessary interventions and how to cope with natural labor by using relaxation, breathing, nutrition, and exercise. The Bradley method also educates women on how to reduce their risk of having a C-section and what to do if it becomes medically necessary.
Choice D reason:
The Bradley method focuses on muscle control because muscle tension increases the pain of labor. This is false because the Bradley method does not focus on muscle control, but rather on deep and complete relaxation during labor. The Bradley method believes that muscle tension interferes with the natural process of labor and increases pain, so it teaches women how to relax their muscles and let their bodies do the work.
Choice E reason:
The Bradley method is the most widely used method in the US. This is false because the Bradley method is not the most widely used method in the US, but rather one of several options for natural childbirth. According to a 2017 survey by Listening to Mothers, only 4% of women reported using the Bradley method for their most recent birth, compared to 48% who used Lamaze, 14% who used hypnobirthing, and 9% who used other methods.