Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A. Administer the insulin to the client
Administer the insulin to the client is incorrect as the nurse should first verify the dosage for safety before administration.
B. Check the dosage with another nurse
Check the dosage with another nurse is correct because double-checking the insulin dosage with another licensed nurse is a critical safety step to prevent medication errors.
C. Check the client's blood sugar again
Check the client's blood sugar again is incorrect; while monitoring blood sugar is important, it is not the immediate next action after preparing the insulin.
D. Ensure a meal tray is available
Ensure a meal tray is available is incorrect; although the client should have a meal ready after insulin administration, the priority action before administering the medication is to confirm the dosage.
This question is an excerpt from Nurse Dive's nursing test bank - Med Surg Exam Antelope Valley College Proctored Exam. Take the full exam now
Full Explanation
A. Administer the insulin to the client is incorrect as the nurse should first verify the dosage for safety before administration.
B. Check the dosage with another nurse is correct because double-checking the insulin dosage with another licensed nurse is a critical safety step to prevent medication errors.
C. Check the client's blood sugar again is incorrect; while monitoring blood sugar is important, it is not the immediate next action after preparing the insulin.
D. Ensure a meal tray is available is incorrect; although the client should have a meal ready after insulin administration, the priority action before administering the medication is to confirm the dosage.
Similar Questions
An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?
A. Reye syndrome
Reye syndrome is correct because administering aspirin to children, especially during viral illnesses like the flu, can lead to this serious and potentially fatal condition characterized by acute encephalopathy and liver failure.
B. Excess antiplatelet action
Excess antiplatelet action is incorrect; while aspirin does have antiplatelet effects, this is not the primary concern in a child with a viral illness.
C. Asthma
Asthma is incorrect; while some individuals with asthma may have sensitivity to aspirin, it is not specifically related to the child's flulike illness.
D. Salicylate poisoning
Salicylate poisoning is incorrect; while high doses of aspirin can lead to toxicity, the immediate risk in the context of flu-like illness is Reye syndrome, which is a more specific concern.
Full Explanation
A. Reye syndrome is correct because administering aspirin to children, especially during viral illnesses like the flu, can lead to this serious and potentially fatal condition characterized by acute encephalopathy and liver failure.
B. Excess antiplatelet action is incorrect; while aspirin does have antiplatelet effects, this is not the primary concern in a child with a viral illness.
C. Asthma is incorrect; while some individuals with asthma may have sensitivity to aspirin, it is not specifically related to the child's flulike illness.
D. Salicylate poisoning is incorrect; while high doses of aspirin can lead to toxicity, the immediate risk in the context of flu-like illness is Reye syndrome, which is a more specific concern.
The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?
A. Sodium levels
Sodium levels are important to monitor, but they are not the primary concern with furosemide treatment.
B. Bone marrow function
Bone marrow function is not a direct concern related to furosemide therapy.
C. Calcium levels
Calcium levels are less critical compared to potassium when monitoring a client on furosemide.
D. Potassium levels
Potassium levels are correct because furosemide is a loop diuretic that can lead to significant potassium loss, putting the client at risk for hypokalemia, which can have serious cardiac implications.
Full Explanation
A. Sodium levels are important to monitor, but they are not the primary concern with furosemide treatment.
B. Bone marrow function is not a direct concern related to furosemide therapy.
C. Calcium levels are less critical compared to potassium when monitoring a client on furosemide.
D. Potassium levels are correct because furosemide is a loop diuretic that can lead to significant potassium loss, putting the client at risk for hypokalemia, which can have serious cardiac implications.
The nurse is caring for a client who has been admitted after an acetaminophen overdose. Which of the nurse's assessment findings suggest liver damage? (Select all that apply.)
A. The client's skin and eyes are visibly jaundiced.
The client's skin and eyes are visibly jaundiced is correct because jaundice indicates a buildup of bilirubin in the blood, which is a sign of liver dysfunction.
B. The client's AST and ALT levels are elevated.
The client's AST and ALT levels are elevated is correct because elevated levels of these liver enzymes indicate hepatocellular injury, which is consistent with liver damage due to acetaminophen overdose.
C. The client's temperature is 102.5° F (39.2° C).
The client's temperature is 102.5° F (39.2° C) is incorrect; while a fever can occur in various conditions, it is not specific for liver damage in this context.
D. The client has an elevated red blood cell count.
The client has an elevated red blood cell count is incorrect; elevated red blood cell counts are not indicative of liver damage and may be related to other factors.
E. The client's eyes are sensitive to light.
The client's eyes are sensitive to light is incorrect; photophobia is not a direct indicator of liver damage and is more related to other conditions.
Full Explanation
A. The client's skin and eyes are visibly jaundiced is correct because jaundice indicates a buildup of bilirubin in the blood, which is a sign of liver dysfunction.
B. The client's AST and ALT levels are elevated is correct because elevated levels of these liver enzymes indicate hepatocellular injury, which is consistent with liver damage due to acetaminophen overdose.
C. The client's temperature is 102.5° F (39.2° C) is incorrect; while a fever can occur in various conditions, it is not specific for liver damage in this context.
D. The client has an elevated red blood cell count is incorrect; elevated red blood cell counts are not indicative of liver damage and may be related to other factors.
E. The client's eyes are sensitive to light is incorrect; photophobia is not a direct indicator of liver damage and is more related to other conditions.