Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is responding to a parent of an adolescent who was recently diagnosed with posttraumatic stress disorder following a sexual assault.
The parent states, "My child ignores curfew, is hanging out with a rough crowd, and has been experimenting with drugs.
Why would they be doing this?" Which of the following responses should the nurse make?.
A. Pill rolling movements and drooling.
A rationale: While it’s important to address the parent’s concerns, this response does not provide the parent with information about why their child might be exhibiting these behaviors.
B. "It is very frustrating when children misbehave.
B rationale: This response does not address the parent’s question about why their child is exhibiting these behaviors.
C. "This must be a difficult time for you.
C rationale: This is the best choice because it provides the parent with information about why their child might be exhibiting these behaviors.
D. "This is normal behavior for an adolescent.
D rationale: This response minimizes the parent’s concerns and does not provide them with information about why their child might be exhibiting these behaviors.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Custom NUR 316 Fall 2023 1MHE Module 4 - 1st 5 units Proctored Exam. Take the full exam now
Full Explanation
Choice A rationale:
While it’s important to address the parent’s concerns, this response does not provide the parent with information about why their child might be exhibiting these behaviors.
Choice B rationale:
This response does not address the parent’s question about why their child is exhibiting these behaviors.
Choice C rationale:
This is the best choice because it provides the parent with information about why their child might be exhibiting these behaviors.
Choice D rationale:
This response minimizes the parent’s concerns and does not provide them with information about why their child might be exhibiting these behaviors.
Similar Questions
A nurse is caring for a client who ingested a selective serotonin reuptake inhibitor and St. John's Wort.
Which of the following findings should the nurse identify as being consistent with serotonin syndrome?.
A. Blood pressure
A rationale: Pill rolling movements and drooling are symptoms of Parkinson’s disease, not serotonin syndrome.
B. Suicidal ideations.
B rationale: Suicidal ideations are a serious mental health concern, but they are not a symptom of serotonin syndrome.
C. Tinnitus and jerking movements.
C rationale: Tinnitus and jerking movements can be symptoms of various conditions, but they are not typically associated with serotonin syndrome.
D. Dilated pupils and loss of muscle coordination.
D rationale: Dilated pupils and loss of muscle coordination are symptoms of serotonin syndrome, which can occur due to an excess of serotonin, often as a result of a combination of medications.
Full Explanation
Choice A rationale:
Pill rolling movements and drooling are symptoms of Parkinson’s disease, not serotonin syndrome.
Choice B rationale:
Suicidal ideations are a serious mental health concern, but they are not a symptom of serotonin syndrome.
Choice C rationale:
Tinnitus and jerking movements can be symptoms of various conditions, but they are not typically associated with serotonin syndrome.
Choice D rationale:
Dilated pupils and loss of muscle coordination are symptoms of serotonin syndrome, which can occur due to an excess of serotonin, often as a result of a combination of medications.
A nurse is caring for a client who has schizophrenia.
Nurses' Notes.
Day 1 1230: A 38-year-old client who has schizophrenia is admitted.
Diagnosed 15 years ago.
Client reports, "I have been hearing voices again telling me to hurt myself.
I hear voices at nighttime so I am not sleeping well.”. Day 1 1730: Vital Signs.
Client consumed 35% of evening meal.
Client appears nervous but reports not hearing voices at this time.
Day 1 1930: Nurse enters client's room.
Client is standing on bed and states, "Do you see that man? He is telling me he is going to hurt me.”. Client pointing to corner of the room.
Client is talking to themselves and states, "I don't want to hurt myself.
Tell the voices to go away!" Nurse asks the client who they are talking to and states, "Tell me more about who is trying to hurt you.”. The nurse is reviewing the client's medical record.
Select the "3" findings that require immediate follow-up by the nurse.
A. The child cries because they are the smallest child in their class.
A rationale: While monitoring blood pressure is important, it is not an immediate concern in this context.
B. Hallucinations.
B rationale: Hallucinations are a serious symptom of schizophrenia and require immediate follow-up.
C. Insomnia.
C rationale: Insomnia can exacerbate the symptoms of schizophrenia and should be addressed promptly.
D. Delusions.
D rationale: Delusions, like hallucinations, are a serious symptom of schizophrenia and require immediate follow-up.
E. Appetite.
E rationale: While monitoring appetite is important, it is not an immediate concern in this context.
Full Explanation
Choice A rationale:
While monitoring blood pressure is important, it is not an immediate concern in this context.
Choice B rationale:
Hallucinations are a serious symptom of schizophrenia and require immediate follow-up.
Choice C rationale:
Insomnia can exacerbate the symptoms of schizophrenia and should be addressed promptly.
Choice D rationale:
Delusions, like hallucinations, are a serious symptom of schizophrenia and require immediate follow-up.
Choice E rationale:
While monitoring appetite is important, it is not an immediate concern in this context.
A nurse is reviewing assessment findings for a 9-year-old child whose family home was destroyed in a wildfire.
The nurse should identify that which of the following behaviors is related to the traumatic experience?.
A. The child cries because they are the smallest child in their class.
A rationale: Being the smallest child in class is not directly related to the traumatic experience of a wildfire.
B. The child is found making small fires in the backyard.
B rationale: Making small fires in the backyard could be a sign of trauma related to the wildfire.
C. The child is rude to their siblings when things do not go their way.
C rationale: Being rude to siblings is not directly related to the traumatic experience of a wildfire.
D. The child insists on having their own way when playing with friends.
D rationale: Insisting on having their own way when playing with friends is not directly related to the traumatic experience of a wildfire.
Full Explanation
Choice A rationale:
Being the smallest child in class is not directly related to the traumatic experience of a wildfire.
Choice B rationale:
Making small fires in the backyard could be a sign of trauma related to the wildfire.
Choice C rationale:
Being rude to siblings is not directly related to the traumatic experience of a wildfire.
Choice D rationale:
Insisting on having their own way when playing with friends is not directly related to the traumatic experience of a wildfire.