COMP. Practice Exam 3

The practical nurse (PN) is reviewing preoperative instructions with a preschooler. Which technique should the PN use to most effectively promote the child's understanding?

B. Allow the child to manipulate some of the equipment to be used.

A client who is 3 days postoperatively for a coronary artery bypass graft surgery (CABG) has a serum potassium level of 4.5 mEq/L. What action should the practical nurse (PN) implement based on this finding?

B. Document the finding only.

The practical nurse (PN) administers a prescribed opiate for a client with acute pancreatitis who is having severe abdominal pain. Which additional intervention in the plan of care should the PN implement?

B. Maintain client's NPO status.

A client with T6 spinal cord injury who is implementing intermittent catheterization for bladder training suddenly complains of a throbbing headache. The practical nurse (PN) determines the client's blood pressure is elevated. What additional assessment should the PN implement?

B. Palpate the client's bladder for distention.

When caring for a client receiving total parenteral nutrition (TPN), which action is most important for the practical nurse (PN) to implement?

B. Perform fingerstick glucose readings q6 hours.

To help prevent complications for a client who is abusing amphetamines, it is important for the practical nurse to implement what action?

B. Perform neurologic assessments.

A male client who is receiving hospice care receives a prescription for radiation therapy for bone metastases. The client tells the practical nurse (PN) that he is on hospice. What information should the PN provide the client?

B. Radiation therapy provides pain relief and is a palliative care measure.

The healthcare provider prescribes wrist restraints for an older male resident in a long term care facility who is confused and has pulled out his urinary catheter twice. The practical nurse (PN) assesses the client's radial pulses and skin condition under the restraint every 2 hours. Which additional measures should the PN implement? Select all that apply.

B. Remove the restraints daily to reevaluate the client's needs. D. Discontinue the restraints when the client is no longer at risk for self injury.

A male client returns to the surgical nursing unit from the postanesthesia care unit and is still drowsy. The practical nurse (PN) uses verbal stimulation to keep the client responsive. In what position should the PN place the client until he is more reactive?

B. Side-lying.

Which finding requires immediate action by the practical nurse (PN)?

B. The weights are touching the floor at the end of the bed.

A male client with acute pancreatitis has a nasogastric tube (NGT) to suction. He asks the practical nurse (PN) if he can have some sips of water or ice chips. Which rationale should the PN explain to the client about remaining NPO?

B. To minimize pancreatic secretions that cause pain.

A client with bipolar disorder is being treated with cognitive therapy. Which actions should the practical nurse (PN) implement to reenforce this treatment strategy? Select all that apply.

B. Use affirmations and limit setting. D. Report client's suicidal expressions to the therapist. E. Encourage substituting positive thoughts for negative thoughts.

A client's cardiac telemetry reveals sinus bradycardia at 40 beats/minute. An IV dose of atropine is given per protocol. Which finding should the practical nurse (PN) identify as a therapeutic response?

C. An increase in heart rate.

A client is admitted with a tumor of the hypothalamus. Which finding should the practical nurse (PN) report to the charge nurse?

C. An oral temperature of 101.8° F.

What method should the practical nurse (PN) implement to elicit information from a client during an admission interview?

C. Ask information-seeking or closed-ended questions.

The practical nurse (PN) is caring for a client following aortic aneurysm resection with graft placement. Which laboratory finding should the PN report to the charge nurse immediately?

C. Blood urea nitrogen 25 mg/dl, creatinine 2.0 mg/dl.

A client is admitted with possible head trauma after a motor vehicle collision. Which action should the practical nurse (PN) implement?

C. Check for verbal and motor response.

The practical nurse (PN) is caring for a client with a chest tube and finds there is an absence of bubbling in the suction control chamber of the chest tube. What action should the PN implement first?

C. Check the tubing for air leaks.

Which acid-base imbalance is a client with a history of severe chronic obstructive pulmonary disease (COPD) likely to develop?

C. Respiratory acidosis.

A client who is ready for transport from the postanesthesia care unit (PACU) to the postoperative unit continues to complain of pain at the incision site. What action should the practical nurse (PN) implement?

C. Consult with the anesthesia healthcare provider for a prescribed dose of analgesia.

Which discharge instructions should the practical nurse (PN) reinforce with a client who has acute cholecystitis?

C. Consume a low-fat diet in smaller, more frequent meals.

Which action should the practical nurse (PN) implement to improve delivery of care by an unlicensed assistive personnel (UAP) who is providing less than optimal hygienic care to older adult clients?

C. Demonstrate to the UAP how to give a gentle bath to a client.

Which action should the practical nurse implement to reduce the risk of edema for a client who had a leg cast applied for a fractured tibia?

C. Elevate the newly casted leg on two pillows.

The practical nurse (PN) deflates a male client's tracheostomy tube cuff to evaluate his ability to swallow. What action should the PN implement?

C. Suction the trachea and then the mouth before deflating the cuff.

A mother who is a single parent of three children comes into the well-child clinic and tells the nurse that she needs to start prenatal visits because she unexpectantly is pregnant. To determine how well the client is coping with the pregnancy, which information should the practical nurse obtain?

C. The client's support person during this pregnancy.

The practical nurse (PN) is preparing to administer erythromycin (Ilotycin) 0.5% ophthalmic ointment to a newborn. The father asks the PN the purpose of this medication. What rationale should the PN provide?

C. To prevent infection in the baby's eyes.

Which task should the practical nurse (PN) assign to an unlicensed assistive personnel (UAP)?

C. Toilet a client on a bladder-training regimen.

The practical nurse (PN) is placing a client who had a knee replacement into a continuous passive motion (CPM) machine. Which action should the PN implement?

C. Ensure the knee is placed correctly to flex with the machine.

An older client who is a resident in a skilled nursing facility likes to walk for exercise. The client is taking a vasodilator for hypertension. Which action should the practical nurse (PN) implement for this client?

D. Assist client to stand up slowly.

A client has collapsed while getting out of bed, has no pulse, and is not breathing. After calling for help and an automated external defibrillator (AED), which action should the practical nurse (PN) take?

D. Begin cardiac compressions.

The practical nurse (PN) assigns the unlicensed assistive personnel (UAP) to take the vital signs for a client with bacterial meningitis. Which finding should the PN direct the UAP to report immediately?

D. Changes in consciousness.

A client's blood pressure is being monitored with an arterial catheter placed in the brachial artery. To prevent neurovascular complications while the catheter is in place, what action should the practical nurse (PN) implement?

D. Check pulses distal to the insertion site hourly.

The practical nurse (PN) is evaluating a client's self management of type 1 diabetes mellitus (DM). Which findings provide the best parameter in the client's goals for the prevention of long-term complications of DM?

D. Consistent hemoglobin A1c levels no greater than 7%.

The practical nurse (PN) explains details of drawing up a dosage of insulin and uses an insulin syringe and vial to show a client how to manipulate the equipment while withdrawing the solution. To evaluate the client's understanding, what action should the PN implement next?

D. Direct client to use the syringe to withdraw a dose of insulin from the vial.

The practical nurse (PN) palpates the insertion site of an IV infusion that is pale and swollen, and determines the area is cool to touch. Which action should the PN implement first?

D. Discontinue the IV infusion.

A client who is taking gentamicin (Garamycin) tells the practical nurse (PN) that he has been hearing ringing in his ears since he began his prescription. What additional assessment finding should the PN report to the healthcare provider?

D. Dizziness.

A male client with a history of a recent stroke has right-sided paralysis, which is his dominant side, and he is unable to speak. Which action in providing hygiene should the practical nurse (PN) implement to encourage the client's rehabilitation?

D. Offer assistance while encouraging client to use left hand to wash face and brush teeth.

Which action should the practical nurse (PN) implement for a young girl with pulmonary infection who is receiving chest physiotherapy?

D. Percuss the chest wall in a rhythmic fashion.

In which position should the practical nurse (PN) place a client after the client has a liver biopsy?

D. Right-side lying.

Twelve hours after implantation of a cervical cesium implant, the practical nurse (PN) finds the client crying. What action should the PN provide?

D. Stand at the head of the bed and offer support for 15 minutes.

A client with deep partial-thickness (second-degree) burns over 70% of his body experiences severe pain with nausea when he is turned for dressing changes. What action should the practical nurse (PN) implement?

A. Administer prescribed morphine sulfate before dressing changes.

A female visitor walks up to the practical nurse (PN) in the hall and asks if the male client who she is visiting is going to recover from his illness. Which response should the PN provide?

A. Explain that client information cannot be shared.

To obtain a client's apical heart rate, which anatomical location should the practical nurse (PN) use when auscultating at the point of maximal impulse (PMI)?

A. Fifth intercostal space, left midclavicular line.

The practical nurse (PN) is caring for a client in the oliguric phase of acute renal failure (ARF). What nursing action should the PN implement?

A. Meticulous skin care.

A male client who had an emergency bowel resection for a ruptured diverticulum 36 hours ago is displaying increased restlessness, and his pulse rate is 110 beats/minute. He is exhibiting gross hand tremors and is plucking at the sheets and gown. During the next 48 hours, it is most important for the practical nurse (PN) to implement what nursing action?

A. Provide a safe environment.

What intervention should the practical nurse (PN) implement to meet the physiologic integrity of a client during a manic episode of bipolar disorder?

A. Provide the client with finger foods.

Which information should the practical nurse (PN) reenforce for a client who has signed an informed consent for a surgery? Select all that apply.

A. The expected benefits and outcomes of the procedure. D. The nature of the therapy or procedure. E. Potential risks of the procedure.

The practical nurse (PN) is administering an otic medication to an adult client. In which direction should the PN pull the pinna during instillation?

A. Up and back.

A client recently diagnosed with diabetes is very angry about the changed circumstances. How should the practical nurse (PN) respond?

A. "You appear upset about the diagnosis. Let's talk about your feelings."

A new mother who delivered vaginally is being discharged today with her first-born infant. Which information is most important for the practical nurse (PN) to review with the client before she goes home with the new infant? Select all that apply.

A. Breast feeding techniques and bottle supplementation. B. Self care of the episiotomy. C. Signs or symptoms of infection.

The practical nurse (PN) gently touches the shoulder of a client who is weeping and who does not want to be in the hospital. What is the purpose of the PN's use of therapeutic touch?

A. Conveys the practical nurse's caring and support when words are difficult.

The practical nurse (PN) is changing the lochia-stained sheets for a client who delivered a normal infant 2 hours ago. What action should the PN take to change the linen? Select all that apply.

A. Dispose lochia-stained disposable peri-pads and bed pads in biohazard boxes. C. Place soiled sheets in a laundry hamper lined with a plastic red bag. D. Use clean gloves during contact with linen and disposable underpads.

Which information is most important for the practical nurse (PN) to obtain when preparing a client for an electroconvulsive treatment (ECT) on an "outpatient" basis? moved before the ECT treatment?

A. Has the client maintained NPO status for 8 hours before the ECT?

The practical nurse (PN) is caring for a female client with a T2 spinal cord injury who is scheduled to begin intensive rehabilitation. When the PN is assisting the client to transfer to a wheelchair, the client tells the PN that she does not feel like getting up. The client complains of a sudden onset of a severe throbbing headache. Which action should the PN implement first?

B. Check the client's blood pressure.

Following a client's bladder surgery, the practical nurse (PN) notes that the ureteral catheter is no longer draining urine. What action should the PN implement?

A. Notify the healthcare provider immediately.

The practical nurse (PN) is interviewing a client who has intermittent chest pain while working in the garden. Which history should the PN obtain that predisposes this client to cardiovascular disease? Select all that apply.

A. Obesity. B. Diabetes. C. Hypertension. D. Hyperlipidemia. E. Family history.

A client who is recently diagnosed with bipolar disorder receives a new prescription for lithium (Eskalith). Which information should the practical nurse (PN) reenforce to ensure the client's understanding?

A. Obtain serum lithium blood levels once a month.

The practical nurse (PN) is preparing to administer nasal drops into the ethmoid nasal sinus cavity. Which actions should the PN implement?

A. Offer a facial tissue to blot nasal secretions after instilling the drops. B. Ask the client to remain supine for 5 minutes after instilling the drops. C. Tilt the client's head backwards over the edge of the bed or over a pillow.

A client who had a cardiac catheterization 2 hours ago has a pressure dressing in the left groin. The practical nurse (PN) is taking vital signs q2 hours. Which additional assessment should the PN make?

A. Pedal pulse.

The practical nurse (PN) is performing a digital extraction of an impaction for an older client. Which finding indicates to the PN that the procedure should be stopped?

A. Slowing heart rate below 60 beats/minute.

When using nonsterile procedure gloves, which action should the practical nurse (PN) implement to ensure standard precautions are provided to all clients?

B. Wash hands immediately after removing the gloves.

Which action should the practical nurse implement when changing bed linens of a client with radioactive implant?

A. Stay at the bedside under the prescribed time exposure.

Which action is most important for the practical nurse (PN) to implement when applying a wet dressing to the skin of a client with impetigo?

B. Wear clean gloves when in contact with wound drainage.

A client who delivered a normal baby 4 hours ago has been unable to void. What nursing intervention should the practical nurse (PN) implement first?

C. Rinse the perineum with warm water.

A male client draws back when the practical nurse (PN) reaches over the side rails to take his blood pressure. To promote effective communication, what should the PN do?

B. Apologize for startling the client and explain the need for contact.

A male client is being discharged after starting a new prescription of olanzapine (Zyprexa) for paranoid schizophrenia. Which discharge instructions should the practical nurse (PN) reinforce with the client?

B. Avoid the use of antihistamines and alcohol.

A client with a massive cerebral bleed who is diagnosed as brain dead is receiving mechanical ventilation. The healthcare provider has just talked to the family about removing the client from life support. Which family concern should the practical nurse (PN) relay to the charge nurse immediately?

B. Client's designation for organ donation.

A client visits the clinic with complaints of sleep loss and wants a prescription for sleeping pills. The practical nurse (PN) learns that the client is also drinking tea at the evening meals. What action should the PN implement?

B. Determine if the tea is caffeinated or has an herbal supplement in it.

A client admitted with major depression is placed on suicide precautions. While orienting the client to the unit, what activity should the practical nurse (PN) implement?

B. Explain the purpose and implementation of suicide precautions.

A client with type 1 diabetes mellitus who uses an insulin pump comes to the clinic for follow-up evaluation. The client consistently has a fasting blood glucose between 70 and 80 mg/dl, a postprandial blood glucose level below 200 mg/dl, and a hemoglobin A1c level of 5.5%. What evaluation should the practical nurse (PN) convey to the client?

B. Good control of blood glucose.

What action should the practical nurse (PN) implement to improve the quality of sleep for a confused client?

B. Keep client awake during the day.

Which information to improve nutritional status should the practical nurse (PN) offer an older female client who lives alone? Select all that apply.

B. Use herbs to spice up the flavor of foods instead of extra salt. D. Cook favorite foods in bulk and freeze in individual serving containers.

A 17-year-old male comes to the clinic for his pre-college physical examination. During the interview, he tells the practical nurse (PN) that although he has been actively engaged in sports, music, and academics, he still does not know what he would like to do after graduation. How should the PN respond?

C. Acknowledge the difficulty of this decision-making while supporting his desire to continue to explore his options.

A 9-year-old boy who had an emergency appendectomy during the night awakens and starts to cry when he does not see his parents at the bedside. He has an IV and a dressing covering the operative site. What action should the practical nurse (PN) implement?

C. Ask the child to recall the surgical event and assess his pain level.

A male client in a skilled nursing home has metastatic cancer and has requested comfort care only. During the day, he does not want to get out of bed because he is too tired and weak to sit in a chair. He sleeps on and off all day and night, his position is changed every 2 hours, and he is comfortable on his pain control regimen. Which action should the practical nurse (PN) implement at the beginning of the next day shift?

C. Assess his desire to get out of bed or remain in bed in a position of comfort.

The practical nurse (PN) is assessing a client who was transferred to the postoperative care unit 1 hour ago. What action should the PN implement to evaluate the client for ineffective airway clearance?

C. Auscultate breath sounds before and after respiratory exercises.

The practical nurse (PN) is reinforcing instructions to a client who is scheduled for a bone marrow aspiration. The PN should prepare the client for the procedure at which site?

D. The posterior iliac crest.

A client with delirium is confused and disoriented to time and place. He states he is experiencing visual illusions and tactile hallucinations. What actions in the plan of care should the practical nurse (PN) implement? Select all that apply.

C. Give simple explanations about nursing care to be given. D. Remove unnecessary furniture and equipment from the room. F. Identify oneself each time the client is approached.

In addition to lowering dietary sodium intake, which dietary changes should the practical nurse (PN) encourage the client to make when learning to manage high blood pressure?

C. Include calcium and magnesium food sources daily.

The practical nurse is discussing glucose balance with a client who is newly diagnosed with type 2 diabetes mellitus. Which physiological process supports the movement of glucose into the cells?

C. Insulin is needed to carry glucose into cells.

The practical nurse (PN) is completing the morning focused assessment for a client who is admitted with cellulitis of the right leg. Which finding about the client's lower extremities is most important for the PN to report immediately to the charge nurse?

C. Pale, cool to the touch, and diminished pulses.

Which action should the practical nurse (PN) implement to facilitate an effective airway clearance for a client who has a stridor and is coughing while experiencing an allergic reaction?

C. Place the client in a high Fowler's position.

A male client is admitted to the hospital for placement of a gastrostomy tube (GT) for enteral feedings and plans to return home where he lives alone. Which information is most important for the practical nurse (PN) to provide to the client?

C. Preoperative instructions regarding the planned surgery.

The practical nurse (PN) is obtaining a history from a client with acute glomerulonephritis (AGN). Which information should the PN ask to focus on this disease etiology?

C. Recent streptococcal infections.

In the prescribed clinical pathway for an elderly client who is bedridden after the repair of a broken hip, transfer to the rehabilitation unit should be implemented at 1 week postoperatively. Which intervention is most important for the practical nurse (PN) to direct the unlicensed assistive personnel (UAP) to implement to ensure the client can progress to this expected outcome?

C. Turn, cough, and deep-breathe q2 hours to prevent secretion pooling in lungs.

An older Hispanic woman is admitted to the skilled nursing facility for rehabilitation following a hip replacement. She is alert, oriented, and cooperative but speaks only Spanish. Her adult children interpret for her when they are present. What management plan to communicate with this client should the practical nurse (PN) implement?

C. Use a translation guide with commonly used pictures and phrases.

A female client is being prepared for pelvic ultrasonography. What information should the practical nurse (PN) give this client in preparation for the diagnostic test?

D. Drink a liter of water 1 hour before the procedure.

The practical nurse (PN) is reinforcing teaching provided to a male client about self administration of subcutaneous insulin. What action should the PN use to best evaluate the client's learning?

D. Use a combination of the client's explanations and demonstration of self injection.

A client with a spinal cord injury is flushed and sweating profusely, complaining of headache and nausea, and has an elevated blood pressure with a slow pulse rate. What intervention should the practical nurse (PN) implement first?

D. Elevate head of the bed to a sitting position.

A male client who was hospitalized for depression 1 month ago is being discharged. The client asks a female practical nurse (PN) for a date when he gets home. How should the PN respond?

D. Explain the nurse-client relationship is a professional relationship, not a social one.

The practical nurse (PN) is examining a newborn and identifies that the gluteal skin folds of the buttocks are uneven and one of the thighs is shorter than the other. Which assessment should the PN implement next?

D. Flex and abduct hips simultaneously

A male client who is newly diagnosed with an ulcer is prescribed an antibiotic. He asks the practical nurse (PN) why this treatment is necessary for an ulcer. What information should the PN provide?

D. Helicobacter pylori infection is a common cause of gastric ulcers.

The practical nurse (PN) is caring for a client with pernicious anemia. What role does gastrin play in this disease?

D. Hormone that stimulates release of gastric juices.

Which client outcome should the practical nurse (PN) identify for a client with heart failure (HF)?

D. The client is able to dress and feed self without experiencing dyspnea.

What should the practical nurse (PN) implement when using active listening as a therapeutic technique during client interaction?

D. Use nonverbal cues such as leaning forward, focusing on the client's face, and slightly nodding.

The practical nurse (PN) observes an unlicensed assistive personnel (UAP) accidentally drop a vial of blood while placing it in a biohazard bag for transport to the laboratory. How should the PN direct the UAP to clean up the blood spill on the floor?

D. Use paper towels to absorb blood for disposal in biohazard container and treat floor with disinfectant.

To prevent atelectasis in an older client who returns from surgery for repair of a hip fracture, what intervention in the plan of care should the practical nurse (PN) implement?

D. Reenforce incentive spirometry given by the respiratory therapist.