Comprehensive - Monday test

Regarding client confidentiality, what information represents the correct understanding by the practical nurse of the guidelines set forth by HIPAA (Health Insurance Portability and Accountability Act)?

Past medical records for clients should be stored in a secured place.

Which factor should the practical nurse (PN) consider prior to providing morning hygiene care to a male client who is of Middle-Eastern descent ?

Personal preferences.

The practical nurse (PN) is caring for a 2-year-old child with Wilms' tumor. Which intervention is most important for the PN to implement?

Place a sign in the room stating no abdominal palpation.

What action should the practical nurse (PN) implement when administering ear drops to a 2-year-old child?

Pull the pinna back and down to instill the drops.

A client who has been taking furosemide (Lasix) for the past two months is 2 days postoperative for a suprapubic prostatectomy. After breakfast, the client is in the bathroom straining to have a bowel movement when he calls the practical nurse (PN) complaining of sudden onset of shortness of breath and acute chest pain. Which condition should the practical nurse (PN) assess the client?

Pulmonary embolism.

A 34-year-old male client who is admitted to the mental health unit for paranoia is responding to antipsychotic medications. After the healthcare team decides to discharge the client, he tells the practical nurse (PN) that his wife is unfaithful and he plans to "get her for this." How should the PN respond?

Report to the team that the client's wife should be informed.

After undergoing exploratory laparotomy and bowel resection, a client with a nasogastric tube (NGT) to suction complains of nausea and stomach distention. The practical nurse (PN) irrigates the tube, but the irrigating fluid does not return. What action should the PN implement?

Reposition the tube and check for placement.

Which finding should the practical nurse report that is the first indication a child with a tracheostomy is experiencing respiratory distress?

Restlessness.

Which finding should the practical nurse (PN) report to the healthcare provider that indicates a client with cirrhosis is progressing to hepatic encephalopathy (hepatic coma)?

Serum ammonia levels twice the normal value.

A client is 24 hours post-endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Which finding should the practical nurse (PN) report to the healthcare provider?

Serum amylase elevation 3 times above normal value.

A new father asks the practical nurse (PN) the reason for placing an ophthalmic ointment in his newborn's eyes. What information should the PN provide?

State law mandates all newborns receive prophylactic treatment to prevent gonorrheal or chlamydial ophthalmic infection.

The practical nurse (PN) is reviewing the use of a new digital thermometer with a group of unlicensed assistive personnel (UAP). Which indicator should the PN use to best evaluate that the UAPs understand the use of the thermometer?

UAPs are repeatedly observed using equipment correctly.

Based on The Joint Commission (TJC) standards for pain assessment and treatment, which action is most important for the practical nurse (PN) to implement when assessing a client?

Use a pain scale to assess all clients for pain when obtaining vital signs.

A client with a common cold is seeking treatment at the health clinic. What information should the practical nurse (PN) reinforce to reduce the spread of infection to family members?

Wash hands after each use of a tissue for nasal drainage.

Which question should the PN ask an older male client to best determine the nature of his pain?

"Can you describe the pain for me?"

The practical nurse (PN) is reinforcing the discharge instructions for a female client with cystitis. Which statement indicates to the PN that the client understands measures to prevent urinary tract infections (UTI)?

"Every 2 to 3 hours during waking hours, I will drink a glass of water and empty my bladder."

Which pathophysiological findings are characteristic in children with cystic fibrosis (CF)? (Select all that apply.)

- Pancreatic enzyme deficiency. - Hypochloremia and hyponatremia. - Viscous respiratory secretions.

A client with hypothyroidism receives a prescription for thyroid hormone replacement. Which sign(s) of overdose should practical nurse (PN) reinforce with the client? (Select all that apply.)

-Nervousness. -Irritability. -Difficulty sleeping

The practical nurse (PN) is assessing a child who has a cast on the right lower leg. Which finding should the PN report to the charge nurse?

A foul odor from the cast's edge.

A child with acute streptococcal pharyngitis is prescribed amoxicillin (Amoxil) suspension. The mother asks the practical nurse (PN) when her child can return to school. Which information should the PN provide?

After the child has taken antibiotics for 24 hours.

Which action should the practical nurse (PN) implement when giving medications to a 3-year-old child?

Allow the child to choose fruit punch or apple juice with oral medica

The nursing staff team includes a registered nurse (RN), a practical nurse (PN), and an unlicensed assistive personnel (UAP). Which task should be assigned to the PN?

Changing decubiti dressings for an immobile client.

The practical nurse (PN) is reviewing dietary recommendations for a client who is newly diagnosed as hypertensive. Which information is most important for the practical nurse (PN) to reinforce?

Check sodium content on all canned foods.

A female client with terminal cancer is tearful and is becoming increasingly withdrawn from her family and the nursing staff. She refuses medications, treatments, food, and frequently says, "Why is God doing this to me?" Which intervention should the practical nurse implement?

Contact her religious advisor to help her face death.

Which action should the practical nurse implement to ensure that a hospitalized toddler takes a prescribed dose of an oral medication?

Convey to the child in simple terms what the medication is for and how it is given.

What action should the practical nurse implement to facilitate speech for a client who has a fenestrated tracheostomy tube?

Determine the client's ability to swallow.

Which information related to a client's history of benign prostatic hypertrophy (BPH) should the practical nurse (PN) report to the healthcare provider?

Difficulty with urination.

The practical nurse (PN) performs a random blood glucose test for a client with a history of hypoglycemia and complains of dizziness. After test completion, which action should the PN perform first?

Dispose of lancet and test strip in proper receptacle.

The practical nurse (PN) is assisting an adult female client with perineal care. Which position should the PN assist the client to take?

Dorsal recumbent.

Which site should the practical nurse (PN) avoid when administering IM immunizations to toddlers?

Dorsogluteal.

The practical nurse (PN) is caring for an older female client who has left-sided weakness after a cerebrovascular accident. The client states that she wants to do her own sponge bath. Which action should the PN implement?

Encourage her to do what she can and assist her when she needs help.

A terminally ill male client and his family are requesting hospice care after discharge and ask the practical nurse (PN) to explain what kind of care they should expect. The PN should indicate that hospice philosophy focuses on what aspect of health care?

Enhances symptom management to improve end-of-life quality.

A female client who is newly diagnosed with Type 2 diabetes tells the practical nurse (PN) that she hates to exercise and asks whether just following her 1000-calorie diet will control her diabetes. Which response should the PN provide that offers the best information?

Exercise facilitates weight loss and decreases peripheral insulin resistance.

An older male client with chronic pain due to degenerative joint disease frequently cries at night because he cannot go to sleep. Which additional finding would the practical nurse (PN) mostly likely observe in this client?

Fatigue, depression, helplessness, and anger.

During a prenatal visit, expectant parents ask the practical nurse (PN) how to safely transport a newborn home in a car seat. What information should the PN provide?

A car seat should be in the rear facing position in the back seat.

The practical nurse (PN) is caring for a client with chronic kidney disease (CKD). What information should the PN reinforce about medication management?

Antihypertensive drugs should always be used as directed.

What action should the practical nurse (PN) take when implementing daily focused assessments for this assigned group of 4 clients?

Apply a blood pressure cuff on client's forearm when the upper arm cannot be used.

When taking the blood pressure of a client, how should the practical nurse (PN) position the client's upper arm?

At the level of the heart.

Which anticholinergic agent is used for bradydysrhythmias?

Atropine.

Which statement by the mother of a newborn should alert the practical nurse (PN) to offer further information about the care of the umbilical cord?

"I can't wait to bathe my baby in the new baby tub as soon as I get home."

The practical nurse (PN) is reviewing the medication dosage instructions with a parent whose child is taking levothyroxine (Synthroid). What statement reveals that the parent understands the correct procedure?

"I give the medication at 8:00 am every day."

A male client diagnosed with schizophrenia reveals to the practical nurse (PN) that voices have told him he is in danger. He believes he is safe only if he stays in his room and wears the same clothes. He goes on, "They're so loud they frighten me. Don't you hear them?" What is the best response for the PN to provide?

"I know these voices are very real to you, but I don't hear them."

The practical nurse provides information to a client about collecting a 24-hour urine specimen. Which statement indicates the client needs additional information?

"I should begin the collection with the first voided specimen when I get up in the morning."

Which interventions should the practical nurse (PN) implement in the postoperative period for a client who had surgery for cancer of the oral cavity? (Select all that apply.)

-Provide meticulous oral hygiene. -Observe for temporary or permanent loss of taste -Obtain daily weights to determine need for NGT feedings.

Rank the sequence of physiological changes that a newborn must initiate and adapt to extrauterine life after Cesarean delivery? (Arrange in the order from most critical on top to least on the bottom.)

1. Initiation of respirations. 2.Maintenance of body temperature. 3.Closure of fetal circulatory shunts. 4.Response of immune defense system.

he practical nurse (PN) is providing wound care for a newly admitted client with partial to full-thickness burns of the torso. Place the steps in the order of first to last implementation. (Arrange from first on top to last on the bottom.)

1. Maintain room temperature above 76 F. 2.Administer prescribed opioid analgesic. 3.Don gown, mask, and gloves. 4.Cleanse wounds with sterile normal saline. 5.Apply topical silver sulfadiazine (Silvadene).

The practical nurse (PN) is administering a dissolved medication via a nasogastric tube (NGT). After putting on gloves and attaching the irrigation syringe to the NGT, in which order should the PN implement the actions? ( Arrange from first on top to last on the bottom.)

1. Pinch the tubing to pour 15 to 30 ml of tap water in the syringe barrel. 2. Release the tubing slowly to allow the solution to flow. 3.Observe the client for indications of intolerance during instillation. 4.Add the medication solution after pinching the tubing.

For which client should the practical nurse implement the Glasgow Coma Scale (GCS) assessment?

A client with a closed head injury who refuses to follow verbal commands.

Which incident should the practical nurse identify as a client confidentiality violation under the Health Insurance Portability Accountability Act (HIPAA) regulations?

A nurse conveys client status information to an inquiring friend on the phone without the client's permission.

Which client requires the most immediate assessment by the practical nurse?

A young adult post-appendectomy with an increase in wound drainage.

Which nursing action for a client who was bitten by a black widow spider is within the scope of practice of the practical nurse (PN)?

Administer intramuscular (IM) tetanus toxoid.

Which intervention is most important for the practical nurse to implement when suctioning the nasopharyngeal airways for a child after cardiac surgery?

Administer supplemental oxygen before and after suctioning.

The practical nurse (PN) is working in the eye clinic where several clients are waiting to be seen. Which client should the PN place in the ophthalmologist's examination room first?

An adult male with a sudden onset of a curtain across field of vision today.

A client with atherosclerosis is trying to stop cigarette smoking and is using a nicotine patch. Which information should the practical nurse (PN) reinforce with this client?

An increased risk for heart attack occurs with smoking while using the patch

Which client is the best assignment for the practical nurse (PN)?

An older adult client with dehydration who needs assistance with feeding.

The practical nurse (PN) receives report for four clients. While providing care, which client should the PN observe closely for hypernatremia?

An older client with quadriplegia who is disoriented today.

What action should the practical nurse (PN) implement first for a client with a head injury and clear nasal drainage?

Check the nasal drainage with a glucose test strip.

An unlicensed assistive personnel (UAP) reports a blood pressure (BP) reading of 148/88 for a 10-year-old child who is above the 95th percentile on the growth chart. What intervention should the practical nurse (PN) implement?

Check the size of the blood pressure cuff used.

A client with acute pancreatitis has a low serum calcium level. The practical nurse (PN) observes that the lips, nose, and side of the face contract after the client's face is cleansed with a cloth. Which electronic documentation describes these findings?

Chvostek's sign noted.

Based on these clients' laboratory results, which client should be assigned to the practical nurse (PN)?

Client with a serum calcium of 9.5 mg/dl.

Which client information determines the best assignment for the practical nurse (PN)?

Client with dependent edema is scheduled for discharge to home care.

Which finding in a newborn is most important for the practical nurse (PN) to report?

Clinical jaundice evident on the forehead within 24 hours of birth.

The practical nurse (PN) is assessing a client who is admitted with a history of heart failure (HF) and a recent onset of dependent edema. Which finding is most important for the PN to report?

Crackles in the lungs.

An older male client who takes several medications comes to the clinic complaining of loss of appetite and fatigue. He tells the practical nurse (PN), "Things look blurred, yellow, and sometimes have rings around them." Which medication should be withheld until further assessment of laboratory tests is obtained?

Digoxin (Lanoxin).

A couple who are both carriers of the sickle cell trait ask the practical nurse (PN) to clarify their children's risk of inheriting this disease?

Each child has a 50% chance of being a carrier.

The unlicensed assistive personnel (UAP) asks the practical nurse (PN) how to position a client for tube feedings?

Elevate the head of the bed.

A client with advanced cirrhosis is prescribed lactulose (Cephulac) 30 ml QID. The client complains that the medicine is causing diarrhea. Which therapeutic response of the medication should the PN provide the client?

Excretes ammonia to improve cerebral function.

The practical nurse (PN) is caring for an older client with an infection. Which finding should the PN anticipate as a delayed response in this client?

Fever.

Which action should the practical nurse (PN) implement to provide a sense of control to a toddler who is hospitalized?

Follow the child's usual routines for feeding and bedtime.

The practical nurse (PN) is planning to attend an educational offering for continuing education units (CEUs) or contact hours. In order to qualify for CEUs, the PN must recognize that the offering should include which essential element?

Has measurable outcome objectives.

At the scene of a motor vehicle collision, the practical nurse (PN) stops to render assistance to a victim who has bleeding injuries of the face and neck. Which action should the PN implement after establishing that the victim is unresponsive?

Immobilize the head and neck.

The practical nurse (PN) is reviewing the medical record for an infant with hydrocephalus. Which focused assessment finding should the PN document?

Increased head circumference.

The practical nurse (PN) is reviewing the effects of nonsteroidal antiinflammatory drugs (NSAIDs) with a client who has acute gastritis. What information is correct about the action of NSAIDs?

Inhibits the synthesis of prostaglandins that normally protect the stomach lining.

The practical nurse (PN) is talking with an adult male client who says that he is satisfied with how he has lived his life. According to Erikson's staging theory, this client is in which stage?

Integrity versus despair.

The practical nurse (PN) is monitoring a client who is admitted in active labor. After reviewing the nursing admission assessment, the PN determines the client's membranes have been ruptured for 36 hours. The PN should monitor the client for which risk factor?

Intrauterine infection.

The caregiver of an 88-year-old client tells the practical nurse (PN) that the client takes frequent naps during the day and awakens frequently during the night. Which information should the PN provide?

It is normal for an aging client to awaken more often during the night and nap during the day.

A client is wearing a continuous 24-hour Holter monitor for evaluation of heart rhythm disturbances. What information should the practical nurse (PN) reinforce with this client?

Keep a diary of activities as long as the monitor is worn.

The practical nurse (PN) is caring for a client with dementia. Which finding should the PN report to the charge nurse that indicates the client's condition is getting worse?

Loss of contact with environment.

Which nursing action for a client who had a near-drowning experience is within the scope of the practical nurse (PN)?

Maintain cervical spine precautions during client transfers to a stretcher.

The practical nurse (PN) is caring for a school-aged child with Reye's syndrome. What action is most important for the PN to implement?

Monitor intake and output

What therapeutic response should the practical nurse (PN) monitor for in a client who is taking medications for tuberculosis?

Negative sputum cultures and chest xray.

Which client receiving infusion therapy is the best assignment for the practical nurse (PN)?

Older adult client who is confused and has a peripheral saline lock that should to be flushed every eight hours.

Which client should the practical nurse (PN) identify as the priority for a focused assessment?

Older female with pneumonia who is newly confused to person.

An infant is admitted to the hospital with dehydration and diarrhea. What is the best liquid that the practical nurse (PN) should provide?

Pedialyte.

A client who delivered a 7 pound 8 ounce infant 3 hours ago has a soft, boggy uterus located above the umbilicus. What action should the practical nurse implement next?

Perform fundal massage.

A male client scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the practical nurse (PN) if he will ever be able to speak. Which response is best for the PN to provide?

Permanent removal of the voice box requires rehabilitation for esophageal speech

An older client is being discharged from the hospital to return to the assisted living community after undergoing a right hip replacement. The client is using a four-point walker. When planning the client's discharge, which member of the healthcare team is most important for the practical nurse to coordinate continued care for the client?

Physical therapist.

The practical nurse (PN) is planning care for a client who is admitted with a Braden scale score of 2 in each of the six subcategories. Toward which goal in the client's care should the PN focus nursing interventions?

Prevention of pressure ulcers.

An infant is admitted to the hospital with a diagnosis of pyloric stenosis. Which finding should the practical nurse (PN) expect to find in the client's history?

Projectile vomiting.

An older Hispanic male is admitted with a nutritional deficiency and is prescribed a regular diet. The client frequently says that he dislikes the hospital foods and wants to eat food brought in by his family. Which response is best for the practical nurse (PN) to provide?

Request that the dietitian review the nutritional content of family foods.

The practical nurse (PN) is caring for a client in hospice who is comatose and needs vigorous suctioning. The PN is conflicted about implementing the needed care. What ethical action should the PN do first?

Speak with the unit supervisor about the problem.

A young child is brought to the emergent care center whose mother is screaming hysterically and states that her child has been beaten. The practical nurse (PN) finds the unlicensed assistive personnel (UAP) crying in the hallway about the child's condition. What action should the PN take?

Support the UAP by going to a private area to talk.

The practical nurse (PN) is observing a newborn's breathing pattern. Which breathing pattern should the PN document as normal for this full-term newborn?

Synchronal chest and abdominal movements.

The practical nurse (PN) receives an assignment of four clients. Which action should the PN implement first?

Take the blood pressures on both arms of a client with moving, "ripping" back pain.

A female client receives a new prescription for an oral contraceptive. Which information should the practical nurse (PN) reinforce with the client?

Take the pill at the same time everyday.

An older client is admitted with anemia after an episode of acute blood loss. Which assessment finding should the practical nurse (PN) report?

Tarry stool last bowel movement.

A mother calls the clinic to find out what she can do because a note from school has been sent about a reported case of head lice in her child's class. What information should the practical nurse (PN) provide?

Tell the child to not share personal grooming items.

The practical nurse (PN) is caring for a client who is receiving a therapeutic dose of warfarin (Coumadin). The client asks the PN to explain the effect of eating green leafy vegetables. What information should the PN provide?

The high content of vitamin K in green leafy vegetables decreases Coumadin's action.

A client with deep partial-thickness and full-thickness burns of the face and chest is receiving wound care using the "open method." The plan of care includes the nursing diagnosis, "Risk for infection related to impaired tissue integrity." Based on the expected outcome, "Client remains free of infections," which nursing intervention should the practical nurse (PN) implement?

Wear gown, cap, mask, and gloves during direct client care.

The practical nurse (PN) is caring for a child who is receiving chemotherapy for leukemia. The child's granulocyte count is 250/ mm 3 and the platelet count is 20,000/ mm 3 . Which intervention should the PN implement when performing oral hygiene?

Wipe teeth with moistened gauze sponges.