Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A school nurse conducting a screening for pediculosis capitis identifies several children who require treatment.
Which of the following instructions should the nurse give the children's parents?
A. Inspect any dogs or cats at home for lice.
Choice A is incorrect because lice are specific to humans and do not infest dogs or cats.
B. Soak all combs and hairbrushes in alcohol.
Choice B is incorrect because soaking combs and hairbrushes in alcohol is not necessary. Instead, they can be soaked in hot water (at least 130°F) for 5-10 minutes.
C. Spray countertops and sinks with insecticide.
Choice C is incorrect because spraying countertops and sinks with insecticide is not necessary and could be harmful.
D. Seal nonwashable items in airtight plastic bags.
The nurse should instruct the children’s parents to seal nonwashable items in airtight plastic bags for at least 72 hours to kill any lice or nits that may be on those items.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Custom SP23 N23 N240 Proctored Exam 3 Ch 11 24 32 43 44. Take the full exam now
Full Explanation
The nurse should instruct the children’s parents to seal nonwashable items in airtight plastic bags for at least 72 hours to kill any lice or nits that may be on those items.
Choice A is incorrect because lice are specific to humans and do not infest dogs
or cats.
Choice B is incorrect because soaking combs and hairbrushes in alcohol is not necessary.
Instead, they can be soaked in hot water (at least 130°F) for 5-10 minutes.
Choice C is incorrect because spraying countertops and sinks with insecticide is not necessary and could be harmful.
Similar Questions
A nurse is caring for a school-age child who has a systemic disorder and is
receiving antibiotics, immunosuppressants, and corticosteroids. Both of the child's parents have a smoking history.
The child reports soreness in his mouth and refuses to eat.
Inspection of his mouth reveals a white, milky plaque that does not come off with
rubbing.
The nurse should suspect which of the following conditions?
A. Dermatitis
Choice A is incorrect because dermatitis is an inflammation of the skin and would not present as a white plaque in the mouth.
B. Candidiasis
The nurse should suspect candidiasis, also known as oral thrush. Candidiasis is a fungal infection that can occur in the mouth and is characterized by the presence of a white, milky plaque that does not come off with rubbing. The child’s use of antibiotics, immunosuppressants, and corticosteroids can increase the risk of developing candidiasis.
C. Herpes simplex
Choice C is incorrect because herpes simplex typically presents as painful blisters or sores in the mouth.
D. Squamous cell carcinoma.
Choice D is incorrect because squamous cell carcinoma typically presents as a firm, painless growth, or ulcer in the mouth.
Full Explanation
The nurse should suspect candidiasis, also known as oral thrush.
Candidiasis is a fungal infection that can occur in the mouth and is characterized by the presence of a white, milky plaque that does not come off with rubbing.
The child’s use of antibiotics, immunosuppressants, and corticosteroids can increase the risk of developing candidiasis.
Choice A is incorrect because dermatitis is an inflammation of the skin and
would not present as a white plaque in the mouth.
Choice C is incorrect because herpes simplex typically presents as painful blisters or sores in the mouth.
Choice D is incorrect because squamous cell carcinoma typically presents as a firm, painless growth, or ulcer in the mouth.
A nurse participating in lead screening at a community center.
The nurse should instruct parents to bring their children back for rescreening in a year for which of the following laboratory values?
A. 10 mcg/dL
A lead level of 10 mcg/dL is above the CDC’s reference value of 3.5 mcg/dL and would require more immediate follow-up and intervention, not just rescreening in one year.
B. 18 mcg/dL
A lead level of 18 mcg/dL is significantly elevated and would necessitate immediate medical intervention and frequent monitoring, rather than waiting a year for rescreening.
C. 4 mcg/dL
A lead level of 4 mcg/dL is slightly above the CDC’s reference value of 3.5 mcg/dL. While it is concerning, it may be appropriate to rescreen in one year if no other risk factors are present.
D. 44 mcg/dL.
A lead level of 44 mcg/dL is dangerously high and requires urgent medical treatment and frequent follow-up, not just rescreening in one year.
Full Explanation
The correct answer is choice C.
Choice A rationale:
A lead level of 10 mcg/dL is above the CDC’s reference value of 3.5 mcg/dL and would require more immediate follow-up and intervention, not just rescreening in one year.
Choice B rationale:
A lead level of 18 mcg/dL is significantly elevated and would necessitate immediate medical intervention and frequent monitoring, rather than waiting a year for rescreening.
Choice C rationale:
A lead level of 4 mcg/dL is slightly above the CDC’s reference value of 3.5 mcg/dL. While it is concerning, it may be appropriate to rescreen in one year if no other risk factors are present.
Choice D rationale:
A lead level of 44 mcg/dL is dangerously high and requires urgent medical treatment and frequent follow-up, not just rescreening in one year.
A nurse is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?
A. Reposition the client by log rolling every 4 hr.
Log rolling is an appropriate technique to reposition a postoperative scoliosis repair patient as it minimizes stress on the spine and helps maintain spinal alignment. Patients need frequent repositioning to prevent pressure ulcers and promote comfort, but every 4 hours may not be frequent enough; typically, every 2 hours is recommended.
B. Place the client in protective isolation.
b. Protective isolation is not typically required for patients undergoing scoliosis surgery unless they have specific risk factors for infection (e.g., immunocompromised status). Standard postoperative care focuses on monitoring for infection at the surgical site rather than isolation unless indicated by the patient's condition.
C. Keep the head of the bed at a 30° angle.
While it’s important to elevate the head of the bed to assist with breathing and comfort, after scoliosis surgery, the head of the bed is generally elevated to 30-45° to facilitate lung expansion and reduce the risk of aspiration. However, it should be ensured that this angle does not compromise spinal alignment, especially in the early postoperative period.
D. Initiate the use of a PCA pump for pain control.
The use of a patient-controlled analgesia (PCA) pump is an appropriate intervention for pain management after scoliosis surgery. It allows the patient to self-administer pain medication within prescribed limits, leading to more effective pain management, improved patient satisfaction, and potentially reduced need for supplemental analgesics.
Full Explanation
a. Log rolling is an appropriate technique to reposition a postoperative scoliosis repair patient as it minimizes stress on the spine and helps maintain spinal alignment. Patients need frequent repositioning to prevent pressure ulcers and promote comfort, but every 4 hours may not be frequent enough; typically, every 2 hours is recommended.
b. Protective isolation is not typically required for patients undergoing scoliosis surgery unless they have specific risk factors for infection (e.g., immunocompromised status). Standard postoperative care focuses on monitoring for infection at the surgical site rather than isolation unless indicated by the patient's condition.
c. While it’s important to elevate the head of the bed to assist with breathing and comfort, after scoliosis surgery, the head of the bed is generally elevated to 30-45° to facilitate lung expansion and reduce the risk of aspiration. However, it should be ensured that this angle does not compromise spinal alignment, especially in the early postoperative period.
d. The use of a patient-controlled analgesia (PCA) pump is an appropriate intervention for pain management after scoliosis surgery. It allows the patient to self-administer pain medication within prescribed limits, leading to more effective pain management, improved patient satisfaction, and potentially reduced need for supplemental analgesics.