Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
Which interventions would the nurse expect in the treatment plan for a patient who is admitted to the hospital with ascites? (Select all that apply.)
A. Monitor fluid and electrolytes.
Monitoring fluid and electrolytes is essential in managing ascites to prevent complications such as fluid overload or electrolyte imbalances, which can exacerbate the condition.
B. Provide a high-sodium diet.
Providing a high-sodium diet is not recommended for patients with ascites. Sodium restriction is typically advised to help manage fluid retention.
C. Anticipate paracentesis.
Anticipating paracentesis is appropriate as it is a procedure used to remove excess fluid from the abdominal cavity, providing relief from discomfort and respiratory difficulty.
D. Encourage high-fluid intake.
Encouraging high-fluid intake is not recommended for ascites management. Fluid restriction may be necessary to prevent further accumulation of fluid in the abdominal cavity.
E. Administer an albumin infusion.
Administering an albumin infusion can be part of the treatment for ascites, especially following paracentesis, to help maintain blood volume and pressure.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Med Surg Proctored Exam Midterm Rn 36 1125. Take the full exam now
Full Explanation
Choice A rationale
Monitoring fluid and electrolytes is essential in managing ascites to prevent complications such as fluid overload or electrolyte imbalances, which can exacerbate the condition.
Choice B rationale
Providing a high-sodium diet is not recommended for patients with ascites. Sodium restriction is typically advised to help manage fluid retention.
Choice C rationale
Anticipating paracentesis is appropriate as it is a procedure used to remove excess fluid from the abdominal cavity, providing relief from discomfort and respiratory difficulty.
Choice D rationale
Encouraging high-fluid intake is not recommended for ascites management. Fluid restriction may be necessary to prevent further accumulation of fluid in the abdominal cavity.
Choice E rationale
Administering an albumin infusion can be part of the treatment for ascites, especially following paracentesis, to help maintain blood volume and pressure.
Similar Questions
A nurse is caring for a client who has end-stage kidney disease and will soon begin hemodialysis treatments. Which of the following restrictions should the nurse discuss with the client that may impact their quality of life? (Select all that apply.)
A. Restricting airplane travel
Restricting airplane travel is not typically necessary for patients on hemodialysis unless there are specific medical concerns or complications related to their condition.
B. Driving restrictions
Driving restrictions are not a standard restriction for patients with end-stage kidney disease unless there are other underlying conditions that impair the ability to drive safely.
C. Time constraints
Time constraints are a significant factor for patients on hemodialysis due to the frequent and lengthy treatment sessions, which can limit their availability for other activities.
D. Limiting social activities to twice a week
Limiting social activities to twice a week is not a standard recommendation; social interactions are important for mental health and should be encouraged as much as the patient's health allows.
E. Restricting foods high in potassium, sodium, and phosphorus
Restricting foods high in potassium, sodium, and phosphorus is crucial for patients with end-stage kidney disease to help manage electrolyte levels and prevent complications.
F. Restricting fluid intake
Restricting fluid intake is essential for patients on hemodialysis to prevent fluid overload, which can lead to heart failure and other serious health issues.
Full Explanation
Choice A rationale
Restricting airplane travel is not typically necessary for patients on hemodialysis unless there are specific medical concerns or complications related to their condition.
Choice B rationale
Driving restrictions are not a standard restriction for patients with end-stage kidney disease unless there are other underlying conditions that impair the ability to drive safely.
Choice C rationale
Time constraints are a significant factor for patients on hemodialysis due to the frequent and lengthy treatment sessions, which can limit their availability for other activities.
Choice D rationale
Limiting social activities to twice a week is not a standard recommendation; social interactions are important for mental health and should be encouraged as much as the patient's health allows.
Choice E rationale
Restricting foods high in potassium, sodium, and phosphorus is crucial for patients with end-stage kidney disease to help manage electrolyte levels and prevent complications.
Choice F rationale
Restricting fluid intake is essential for patients on hemodialysis to prevent fluid overload, which can lead to heart failure and other serious health issues.
After assessing a patient with ulcerative colitis (UC), the nurse concludes that the patient has moderate disease. Which patient symptoms support the nurse's conclusion? (Select all that apply.)
A. Anorexia
Anorexia, or loss of appetite, is common in UC due to abdominal pain and discomfort, as well as the psychological impact of chronic illness.
B. Rectal bleeding
Rectal bleeding is a hallmark symptom of UC, indicating moderate to severe inflammation of the colon, which can lead to ulcers and bleeding.
C. Left lower quadrant pain
Left lower quadrant pain is typical in UC because the disease often affects the descending colon, which is located in this area.
D. Right lower quadrant pain
Right lower quadrant pain is more characteristic of conditions like appendicitis. UC typically does not cause pain in this area unless it is extensive and involves the right colon.
E. Steatorrhea
Steatorrhea, or fatty stools, can occur in UC if the disease affects the ileum, leading to malabsorption of fats.
Full Explanation
Choice A rationale
Anorexia, or loss of appetite, is common in UC due to abdominal pain and discomfort, as well as the psychological impact of chronic illness.
Choice B rationale
Rectal bleeding is a hallmark symptom of UC, indicating moderate to severe inflammation of the colon, which can lead to ulcers and bleeding.
Choice C rationale
Left lower quadrant pain is typical in UC because the disease often affects the descending colon, which is located in this area.
Choice D rationale
Right lower quadrant pain is more characteristic of conditions like appendicitis. UC typically does not cause pain in this area unless it is extensive and involves the right colon.
Choice E rationale
Steatorrhea, or fatty stools, can occur in UC if the disease affects the ileum, leading to malabsorption of fats.
A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.)
A. Apply a new patch at the onset of anginal pain.
Applying a new patch at the onset of anginal pain is not recommended for transdermal nitroglycerin. This medication is used for long-term prevention of angina, not for immediate relief.
B. Apply the patch to dry skin and cover the area with plastic wrap.
Covering the patch with plastic wrap is not necessary and is not a standard instruction for the use of transdermal nitroglycerin patches.
C. Apply a new patch each morning.
Applying a new patch each morning ensures that the medication is delivered consistently throughout the day, which is important for the management of stable angina.
D. Remove the patch for 10 to 12 hours daily.
Removing the patch for 10 to 12 hours daily, typically at night, helps prevent tolerance to the medication, ensuring its effectiveness.
E. Apply the patch to a hairless area and rotate sites.
Applying the patch to a hairless area and rotating sites helps to prevent skin irritation and ensures better adherence of the patch to the skin.
Full Explanation
Choice A rationale
Applying a new patch at the onset of anginal pain is not recommended for transdermal nitroglycerin. This medication is used for long-term prevention of angina, not for immediate relief.
Choice B rationale
Covering the patch with plastic wrap is not necessary and is not a standard instruction for the use of transdermal nitroglycerin patches.
Choice C rationale
Applying a new patch each morning ensures that the medication is delivered consistently throughout the day, which is important for the management of stable angina.
Choice D rationale
Removing the patch for 10 to 12 hours daily, typically at night, helps prevent tolerance to the medication, ensuring its effectiveness.
Choice E rationale
Applying the patch to a hairless area and rotating sites helps to prevent skin irritation and ensures better adherence of the patch to the skin.