Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse practitioner is treating a 17-year-old boy who sustained an open tibial fracture in a motor vehicle crash. Which of the following is the most appropriate treatment choice for a grade 1 open fracture?
A. Aminoglycosides
Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
B. Cephalosporins
Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
C. High-dose penicillin
High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
D. Sulfamethoxazole and trimethoprim
Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
Choice B reason: Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
Choice C reason: High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
Choice D reason: Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
Similar Questions
A 36-year-old man is evaluated by the PMHNP for a recent incident in which he stayed up for several nights in a row, had much more energy than usual, and believed he was talking to God. He was diagnosed with bipolar disorder. In reviewing his medications, the PMHNP finds he is taking acetaminophen 500 mg BID, bupropion XL (Wellbutrin) 150 mg once daily, Sam-E for pain from an old football injury, and alprazolam 0.5 mg pm for agitation. Which of these should be discontinued immediately?
A. Acetaminophen (Tylenol)
Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
B. Sam-E
Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
C. Bupropion (Wellbutrin)
Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
D. Alprazolam (Xanax)
Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
Full Explanation
Choice A reason: Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
Choice B reason: Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
Choice C reason: Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
Choice D reason: Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
A 62-year-old woman presents to the PMHNP for an evaluation. She is concerned she is developing dementia due to her significant family history. Which of the following would help the PMHNP make a diagnosis of pseudodementia rather than dementia?
A. Patients with pseudodementia are more likely to say "I don't know" when uncertain.
Individuals with pseudodementia, often related to depression, tend to respond to cognitive testing with "I don’t know" when uncertain, showing awareness of deficits. This contrasts with true dementia, where patients often confabulate or attempt to answer despite impaired memory.
B. In patients with dementia, attention and concentration are variable.
In dementia, attention and concentration are consistently impaired, not highly variable. This makes the statement inaccurate for distinguishing pseudodementia.
C. Patients with true dementia are less likely to have language impairment and to confabulate.
True dementia commonly involves language impairment and confabulation. The statement is incorrect in suggesting the opposite.
D. In patients with pseudodementia, intellectual performance is usually global, and impairment is consistently poor.
In pseudodementia, intellectual performance is typically intact outside of depressive episodes, and deficits are inconsistent, making the statement inaccurate.
Full Explanation
Choice A reason: Individuals with pseudodementia, often related to depression, tend to respond to cognitive testing with "I don’t know" when uncertain, showing awareness of deficits. This contrasts with true dementia, where patients often confabulate or attempt to answer despite impaired memory.
Choice B reason: In dementia, attention and concentration are consistently impaired, not highly variable. This makes the statement inaccurate for distinguishing pseudodementia.
Choice C reason: True dementia commonly involves language impairment and confabulation. The statement is incorrect in suggesting the opposite.
Choice D reason: In pseudodementia, intellectual performance is typically intact outside of depressive episodes, and deficits are inconsistent, making the statement inaccurate.
A mother presents to the nurse practitioner with her 10-year-old son for a routine well check and a flu shot. She asks the NP if there are any vaccines he is not up-to-date on. The NP explains that the HPV vaccine (Gardasil 9) is indicated for which of the following groups?
A. Girls and women aged 9-26
HPV vaccination is not limited to females; males are also recommended to receive it for prevention of HPV-related diseases.
B. Boys and men aged 9-26
While males are indicated, vaccination is not limited to them; females are also recommended.
C. Girls and boys aged 11-12
While routine vaccination is ideally given at ages 11-12, catch-up vaccination is recommended through age 26, making this choice incomplete.
D. All children and adults aged 9-26
The HPV vaccine is indicated for all children and adults aged 9-26, including both genders, for both routine and catch-up vaccination.
Full Explanation
Choice A reason: HPV vaccination is not limited to females; males are also recommended to receive it for prevention of HPV-related diseases.
Choice B reason: While males are indicated, vaccination is not limited to them; females are also recommended.
Choice C reason: While routine vaccination is ideally given at ages 11-12, catch-up vaccination is recommended through age 26, making this choice incomplete.
Choice D reason: The HPV vaccine is indicated for all children and adults aged 9-26, including both genders, for both routine and catch-up vaccination.