Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse should assign which of the following tasks to an assistive personnel?
A. Giving oral care to a client who cannot take oral fluids
Giving oral care to a client who cannot take oral fluids is a task that can be safely delegated to an assistive personnel.
B. Checking intravenous insertion sites for signs of infiltration
Checking intravenous insertion sites for signs of infiltration requires nursing judgment and assessment skills and should be performed by a licensed nurse.
C. Assessing a client's ability to ambulate
Assessing a client's ability to ambulate involves clinical judgment and should be performed by a licensed nurse.
D. Demonstrating to a client with diabetes mellitus how to use the glucometer
Demonstrating how to use a glucometer to a client with diabetes requires nursing knowledge and education skills and should be performed by a licensed nurse.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Rn Fundamentals Proctored Exam 6. Take the full exam now
Full Explanation
A. Giving oral care to a client who cannot take oral fluids is a task that can be safely delegated to an assistive personnel.
B. Checking intravenous insertion sites for signs of infiltration requires nursing judgment and assessment skills and should be performed by a licensed nurse.
C. Assessing a client's ability to ambulate involves clinical judgment and should be performed by a licensed nurse.
D. Demonstrating how to use a glucometer to a client with diabetes requires nursing knowledge and education skills and should be performed by a licensed nurse.
Similar Questions
A nurse is preparing to administer dextrose 5% in 0.45% sodium chloride 1,200 mL IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr?
(Round the answer to the nearest whole number. Use a leading zero is applicable. Do not use a trailing zero.)
Full Explanation
The question is about calculating the IV infusion rate for a given solution and volume.
The formula for the infusion rate is: (volume in mL / time in hours) x drop factor in gtts/mL = infusion rate in gtts/min
The drop factor is usually given on the IV tubing package and varies depending on the type of tubing used.
For this question, we can assume a drop factor of 15 gtts/mL, which is common for macrodrip tubing.
Plugging in the numbers, we get: (1200 mL / 8 hr) x 15 gtts/mL = 2250 gtts/hr
To convert from gtts/hr to mL/hr, we divide by the drop factor: 2250 gtts/hr / 15 gtts/mL = 150 mL/hr
Therefore, the nurse should set the IV pump to deliver 150 mL/hr.
A guard at a prison brings an injured inmate to the facility clinic. The inmate is bleeding, and the guard asks the nurse about the inmate's HIV infection status. Which of the following actions by the nurse is appropriate?
A. Have the guard sign a release of information form.
Having the guard sign a release of information form may not be appropriate in an emergency situation, and immediate action is needed to address the injury.
B. Tell the guard to submit an inmate inquiry form to the warden.
Telling the guard to submit an inmate inquiry form to the warden may delay necessary medical intervention in an emergency.
C. Complete an incident report.
Completing an incident report is appropriate to document the situation and the care provided.It is not necessary to disclose the inmate's HIV status in the report.
D. Instruct the guard to ask the inmate.
Instructing the guard to ask the inmate is not a proper approach to handling a medical emergency. The nurse should focus on providing immediate care to the injured inmate.
Full Explanation
A. Having the guard sign a release of information form may not be appropriate in an emergency situation, and immediate action is needed to address the injury.
B. Telling the guard to submit an inmate inquiry form to the warden may delay necessary medical intervention in an emergency.
C. Completing an incident report is appropriate to document the situation and the care provided It is not necessary to disclose the inmate's HIV status in the report.
D. Instructing the guard to ask the inmate is not a proper approach to handling a medical emergency. The nurse should focus on providing immediate care to the injured inmate.
A nurse is caring for a client who had a cerebrovascular accident and is at risk for falls. The nurse should recognize that which of the following is an appropriate safety precaution?
A. Monitor the client at least once every hr.
Monitoring the client at least once every hour is an appropriate safety precaution to assess the client's condition and prevent falls.
B. Assign the client to a private room.
Assigning the client to a private room may not directly address the risk of falls and may not be necessary for fall prevention.
C. Request a PRN prescription for restraints.
Requesting a PRN prescription for restraints should not be the first line of defense for fall prevention and should only be considered when other interventions are ineffective or inappropriate.
D. Keep four side rails up while the client is in bed.
Keeping four side rails up while the client is in bed can be a restraint and may increase the risk of injury. It is not a recommended approach for fall prevention.
Full Explanation
A. Monitoring the client at least once every hour is an appropriate safety precaution to assess the client's condition and prevent falls.
B. Assigning the client to a private room may not directly address the risk of falls and may not be necessary for fall prevention.
C. Requesting a PRN prescription for restraints should not be the first line of defense for fall prevention and should only be considered when other interventions are ineffective or inappropriate.
D. Keeping four side rails up while the client is in bed can be a restraint and may increase the risk of injury. It is not a recommended approach for fall prevention.