Medical-Surgical Assignment Exam Dr. P

A male client is admitted after being hit on the head with a tire iron. In the change-of-shift report, the client's Glasgow Coma Scale (GCS) score is 14, and pulse (P) 90 beats/minute (bpm), respirations (R) 18 breaths/minute, and blood pressure (BP) 104/60. Which finding is most important for the practical nurse to follow-up when checking the client after the shift change?

Current GCS score is 12.

A male client arrives at the clinic for a routine physical examination and states he suddenly does not feel well. The practical nurse (PN) obtains the client's vital signs. Which assessment finding has the highest priority?

The oxygen saturation of 88%.

The practical nurse (PN) is irrigating the eye of a male client who had a known alkaline substance splashed into his eye. Which finding indicates the PN should stop the procedure?

The pH is 7.4 in the affected eye.

What statement by the client should alert the practical nurse that immediate attention by the ophthalmologist is necessary?

"I now see halos around lights."

The practical nurse (PN) is reviewing prescriptions for four clients. Which prescription should the PN question?

Encourage incentive spirometer PRN for wheezing.

A client presents to the clinic complaining of severe stabbing pain in the epigastric region that radiates to the mid-back area. Which finding indicates to the practical nurse that the client should remain NPO?

Amylase and lipase levels are 3 times the normal value.

During admission to the medical unit, a client with bacterial meningitis complains that the light is hurting his eyes and he has a headache. The practical nurse (PN) reviews the client's pervious neurological responses and obtains the client's temperature, which is 103.1 F (39.5 C). Which action should the PN implement next?

Begin a secondary infusion of the prescribed antibiotic.

A client with a vertebral fracture at T3 after falling from a roof is sent for radiological testing. Which assessment is a priority for the practical nurse (PN) to implement when the client returns to the unit?

Bilateral hand grip and strength.

A 55-year-old male client with an abdominal aortic aneurysm (AAA) presents to the emergent care center reporting abdominal and scrotal pain and feeling dizzy. Which finding should the practical nurse report to the healthcare provider?

Blood pressure of 160/90.

The practical nurse (PN) is reviewing the admission data for an older male with benign prostatic hyperplasia (BPH). Which finding should the PN report to the healthcare provider?

Blood urea nitrogen (BUN) is 50 mg/dl.

A male client calls the clinic and reports he is having heavy chest pressure after exercising. He tells the practical nurse (PN) that he took three nitroglycerin sublingual (SL) tablets without relief. What instruction should the PN provide?

Call 911 immediately.

An adult client presents to the emergent care center with hives and laryngeal edema after being stung by a bee. Following successful treatment, what information is most important for the practical nurse to reinforce with the client upon discharge?

Carry an epinephrine pen.

The practical nurse (PN) performs a Glasgow Coma Scale (GCS) assessment for a client who experienced an acute brain attack (stroke) yesterday and obtains a score of "12." What assessment should the PN do next?

Comparison of GCS score with previous checks.

An older female client with heart failure (HF) calls the clinic and tells the practical nurse (PN) that she has been coughing after starting the prescription, captopril (Capoten). Which information by the client requires further investigation by the PN?

Complains her shoes are too snug to wear.

The practical nurse (PN) is caring for a client with trigeminal neuralgia associated with Cranial Nerve V pathology. While reinforcing the discharge teaching instructions, the PN should include which information?

Encourage a soft diet to minimize chewing.

A female client who is currently receiving chemotherapy (CT) for colon cancer tells the practical nurse (PN) that she plans to become pregnant in case CT is not successful. What action should the PN take?

Encourage her to wait until the completion of chemotherapy.

A client with myasthenia gravis is admitted in myasthenic crisis. Which priority action should the practical nurse (PN) implement?

Determine client's ability to swallow

A male client with pancreatic cancer who received morphine and midazalom (Versed) during an endoscopic retrograde cholangiopancreatography (ERCP) returns to the unit. His vital signs are pulse 80 beats/minute, 16 breaths/minute, blood pressure 120/80, and pulse oximeter 98%. Which action should the practical nurse (PN) implement?

Determine client's fingerstick glucose level.

After a client reports having frothy, floating stools with a foul odor, what area of the client's history should the practical nurse review?

Dietary fat intake.

A client who had an abdominal cholecystectomy today has a T-tube that has drained 200 ml of greenish-brown fluid in the past 12 hours. What action should the practical nurse (PN) take?

Document the findings in the electronic medical record.

Which information should the practical nurse (PN) reinforce with a female client who has a history of frequent urinary tract infections (UTI)?

Drink a glass of cranberry juice daily.

A client recovering from a gastrojejunostomy (Billroth II) surgery reports dizziness, weakness, palpitations, and an urge to defecate about 20 minutes after eating. What teaching should the practical nurse reinforce with the client?

Eat low-carbohydrate foods 6 times/day.

Two days after a small bowel resection, a male client reports tingling of fingers and toes and feels dizzy. The client's nasogastric tube (NGT) is draining per low intermittent suction, and the practical nurse (PN) suspects the client has a fluid and electrolyte imbalance because he has been taking oral ice chips PRN. Which assessment finding should the PN report when monitoring the client?

Elevated pulse and dysrhythmia noted on telemetry.

The practical nurse (PN) recognizes which stool characteristics as typical of a client with acute cholecystitis?

Pale, floating.

A male client who fell from a fire escape staircase has no sensation or movement of his lower extremities. His vital signs are heart rate 54 beats/minute, respirations 20 breaths/minute, blood pressure 86/50, and pulse oximetry 95%. He is admitted with an normal saline IV infusion to maintain perfusion, and his skin is cool, dry, and pink. Which action is most important for the practical nurse to implement?

Monitor hourly urinary output per indwelling catheter.

A male client who was recently diagnosed with Guillain-Barr syndrome (GBS) tells the practical nurse (PN) that the paralysis of his lower extremities is climbing. What is the most important intervention for the PN to implement?

Monitor respiration depth.

The practical nurse (PN) is caring for a male client who had laparoscopic removal of a kidney tumor this morning. Which priority assessment should the PN include during the immediate postoperative period?

Urinary output.

The practical nurse (PN) is preparing a male client for discharge when he begins to complain of dyspnea. The client's vital signs are pulse at 90 beats/minute, respirations 24 breaths/minute, blood pressure 140/70, and oxygen saturation of 91%. After supplemental oxygen is provided, the client's oxygen saturation is 99%. Which assessment provides the best indication that the client is ready for discharge?

Oxygen saturation without oxygen.

The practical nurse (PN) is discussing cancer screening for a group of women who attend a healthy living seminar at the clinic. What information should the PN review?

The Pap smear test is recommended when sexual activity begins.

The practical nurse (PN) is reinforcing discharge instructions for a client with a concussion. Which client goal should the PN emphasize as the client's highest priority?

The spouse will regularly check on the client's level of responsiveness.

The practical nurse (PN) is transferring a client to the in-patient dialysis unit for hemodialysis scheduled for today. Which information is essential for the PN to report to the receiving nurse?

Today's hemoglobin result of 8.0 grams.

The practical nurse (PN) is assigned to care for a client with a radium implant for cervical cancer. Which intervention should the PN implement while providing care?

Wear the film badge while in the clients room.

The practical nurse (PN) at an extended care facility is called to the unit's activity room where a client has "fainted." Which finding indicates to the PN that the client experienced a syncopal episode?

A sudden experience that everything went black.

A client with chronic kidney disease (CKD) has a serum potassium level of 7.0 mEq/L. Which prescription should the practical nurse administer?

50% dextrose and regular insulin IV.

A client presents to the clinic reporting a new onset of blurred vision. Which assessment should the practical nurse implement to evaluate the client's central vision acuity?

A Snellen chart.

The practical nurse (PN) is caring for a client who is 2 days postoperatively for a total colectomy. Which finding requires immediate intervention by the PN?

A board-like abdomen.

The practical nurse (PN) is caring for a group of clients on a telemetry unit. Which client requires immediate follow-up by the PN?

A client with multiple premature ventricular contractions (PVC)/minute after receiving atropine.

On admission, a client with an acute myocardial infarction receives a thrombolytic, aspirin, and IV heparin. Which finding indicates to the practical nurse (PN) that the client is having a therapeutic response to the medication?

Activated partial thromboplastin time (APTT) results 2 times the control.

A client presents to the urgent care clinic with a sudden onset of left upper quadrant pain radiating to the back. Based on which laboratory values should the practical nurse (PN) ensure the client remains NPO? (Select all that apply.)

Amylase is 660 units/L. Lipase is 1600 units/L.

A client who is 12-hours postoperatively for a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) is refusing to turn and perform postoperative leg exercises. What action should the practical nurse take?

Apply bilateral compression stockings (TEDs).

The practical nurse (PN) observes that the dressing of a client with a gunshot wound to the groin is saturated with bright red blood. Which is the PN's priority action?

Apply direct pressure to the area.

An adult male arrives at the emergent care clinic complaining of a high fever and a severe sore throat. The practical nurse (PN) observes that the client is irritable, breathing with his mouth open, and drooling. What action should the PN take?

Assemble supplies for endotracheal intubation.

A client who accidentally received an electrical shock at work and temporarily lost consciousness is brought to the emergent care center by his supervisor because the client states that he doesn't feel well. What intervention should the practical nurse implement first?

Attach a cardiac monitor.

A male client is admitted with encephalitis and hourly neurological assessments are prescribed. At 0300, the client reports a headache rated at "8" on 0 to 10 pain scale. The practical nurse (PN) administers a prescribed PRN analgesic at 0315, and notes the client is asleep and snoring at 0400. What priority action should the PN take?

Awake the client to check response to stimuli.

When assisting the nurse in the collection of a specimen for arterial blood gases (ABG), which action should the practical nurse (PN) implement?

Compress radial and ulnar arteries and release to evaluate skin color.

The practical nurse (PN) is assisting with the admission of a client with postnecrotic cirrhosis. Which finding is most important for the PN to report to the charge nurse?

Confusion times one (person).

The practical nurse (PN) is assessing breath sounds of a client who has spontaneous respirations after an endotracheal tube (ET) insertion. The breath sounds are absent on the left side. What action should the PN do?

Contact the nurse in charge immediately.

A client with chronic obstructive pulmonary disease (COPD) is using pursed-lip breathing while he is sitting up in a chair by the bedside. The practical nurse (PN) obtains his respiratory rate at 20 breaths/minute and his pulse oximetry is 91% on room air. What action should the PN implement?

Encourage the client to sit up and lean forward.

A client is brought to the emergent care center for chest pain and receives morphine, oxygen, nitroglycerin, and aspirin per acute coronary syndrome (ACS) protocol. Which additional protocol prescriptions should the practical nurse obtain from the emergency medication cart?

Eptifibatide (Integrilin), a glycoprotein (IIb/IIIA) inhibitor.

A client with a ventriculoperitoneal shunt has large bruises on the forehead and arm. The practical nurse (PN) at the outpatient clinic determines that the client received the bruises accidentally while walking through the doorways at home. What action should the PN take?

Evaluate the client's pupillary response to light.

The practical nurse (PN) is caring for client who returned to the unit after a cardiac catheterization. Which finding should the PN report to the nurse?

Faint pedal pulses.

When performing a focused neurological assessment for an adult client, which finding should the practical nurse report to the charge nurse?

Flexion decorticate posturing

The practical nurse (PN) is caring for a client with cancer who is receiving chemotherapy (CT) and is nauseated. Which intervention should the PN implement to promote adequate nutrition for the client?

Give an antiemetic prior to the administration of CT.

An older client is seen in the clinic for an annual physical exam. Which finding should the practical nurse report to the healthcare provider for follow-up?

Hemoglobin 9.1 grams/dl with positive occult blood in stool.

A client is found pulseless and unresponsive with the telemetry showing a rapid, wide QRS complex. What should the practical nurse do first?

Initiate cardiac compressions.

A client with type II diabetes mellitus (DM) is admitted with an infected foot ulcer. Which prescription should the practical nurse (PN) implement first

Intravenous antibiotics.

A male client is admitted to the medical unit after falling off a second story roof to a concrete sidewalk. The client's skin is warm and pink, and his vital signs are heart rate 60 beats/minute, respirations 26 breaths/minute, blood pressure 80/48. Which action is most important for the practical nurse to implement?

Maintain normal saline infusion and IV access.

A male client with emphysema is using pursed-lip breathing and reports to the practical nurse (PN) that he is having a more difficult time breathing. Which intervention should the PN implement?

Lean the client forward on both forearms while sitting.

A client returns to the unit after spinal anesthesia for surgical removal of left tibial hardware. Which finding requires further action by the practical nurse?

Left pedal pulses barely palpable.

The practical nurse (PN) is caring for a client who had a lumbar laminectomy 4 hours ago. Which finding should the PN report to the healthcare provider?

Leg muscle strength grade 2.

The practical nurse (PN) is monitoring a client with a comminuted fracture of the left femur. Which finding should the PN report to the healthcare provider immediately?

Leg pain of "10" unrelieved by opioids.

The practical nurse (PN) is caring for an elderly client with a history of heart failure (HF) who suddenly wakes up in the middle of the night complaining of being unable to breathe. What action should the (PN) implement?

Listen to bilateral lung fields.

A client presents to the emergent care center with symptoms on an acute brain attack and right sided facial drooping. Which action should the practical nurse (PN) implement first?

Maintain the client NPO.

The practical nurse (PN) receives shift report about a client whose chest x-ray reveals "free air under the right diaphragm." What action should the PN take?

Maintain the client NPO.

An older client who is at a health fair goes to the First Aid station and reports feeling tired after a recent screening test revealed a hemoglobin of 10.1 grams. The client asks the practical nurse (PN) what could he do to feel better. What information should the PN offer?

Make appointment with healthcare provider.

The practical nurse (PN) notes an irregular radial pulse for a client who has an implanted pacemaker. What action should the PN do first?

Measure the apical-radial pulse with another nurse.

Which action should the practical nurse (PN) implement for a client who is having a liver biopsy?

Monitor for signs of dyspnea after return from biopsy.

A client who is hit on the head with a baseball bat is admitted for observation. The practical nurse (PN) notes clear liquid leaking from the client's ear. What action should the PN take?

Observe the collected fluid for blood surrounded by a yellow ring.

A male client with a chest tube and a three-chamber water seal drainage system calls the practical nurse (PN) to the bedside and says his chest tube (CT) is not working. The PN observes that the client's respiratory effort and breath sounds are normal. Which action should the PN implement?

Observe the water-seal chamber for bubbling.

An older client is manifesting third-degree heart block on the telemetry monitor. The client's vital signs are apical pulse 30 beats/minute, respirations 12 breaths/minute, and blood pressure 70/50. Which initial intervention should the practical nurse anticipate?

Obtain the external pacer and crash cart.

Which finding is an early indication that a recently applied leg plaster cast is causing compartment syndrome?

Paresthesia.

Which finding by the practical nurse is the best indication that a client's peristalsis has returned after abdominal surgery?

Passes flatus per rectum.

What action should the practical nurse (PN) implement for a client who has a banana allergy?

Place a box of latex-free gloves in the room.

A client who is involved in a motor vehicle collision (MVC) is admitted for evaluation. After a chest xray, the practical nurse (PN) reports that the client is dyspneic, has decreased right breath sounds, normal left field breath sounds, and tracheal deviation. After notification of the healthcare provider, what priority action should the PN implement?

Prepare for emergency chest tube insertion.

A client who is one-day post-thyroidectomy begins to develop a stridor. Which priority action should the practical nurse implement?

Prepare for emergency tracheotomy at the bedside.

A client who is positive for human immunodeficiency virus (HIV) comes to the clinic for a routine check up. During the initial interview, the client's partner tells the practical nurse (PN) that the client has had several occasions of mental confusion. The PN should focus questions to determine if the client is developing which opportunistic infection?

Toxoplasmosis.

A client receives pulmonary resuscitation with an Ambu bag for 10 minutes before being intubated with a endotracheal tube (ET). The practical nurse (PN) notes that the client's stomach is distended. What action should PN implement?

Prepare to insert a nasogastric tube.

Which technique should the practical nurse implement for a male client who does not response to nail bed pressure during a focused neurological assessment?

Provide painful stimuli using a sternal rub technique

An adult male arrives in the clinic an hour after he was hit on the right side of the head in a golfing accident. The client is taking warfarin (Coumadin) for atrial fibrillation. Which finding should the practical nurse report to the healthcare provider immediately?

Pupil size, right 7 mm and left 5 mm

The practical nurse (PN) is reviewing the complete blood count results for a male client with a wound infection and determines the results indicate leukocytosis. What intervention should the PN implement?

Recognize this is an indication of the body's response to fighting the infection.

The practical nurse (PN) is caring for a client who has increased intracranial pressure (ICP) and a nursing diagnosis of "Ineffective breathing pattern." Which intervention should the PN use as the best measure for attainment of the goal, "Client will have adequate oxygenation?"

Review current results of arterial blood gas studies.

A client who is 12 hours postoperative for a right total knee replacement (TKR) is receiving epidural pain management. Which finding requires additional follow-up by the practical nurse (PN)?

Right dorsal pedal pulse absent upon palpation.

After attending a class on testicular self-examination (TSE), a client reviews the examination's components with the practical nurse (PN). Which comment should the PN confirm with the client as correct self-examination technique?

Roll each testis between thumb and fingers.

The practical nurse (PN) completes a focused assessment for a client with a possible brain attack (stroke). Which finding requires further assessment by the PN?

Somnolence when questioned.

The practical nurse (PN) determines that a female client who is returning to the clinic with urinary urgency, frequency, and burning on urination has been in the clinic several times in the past few months with urinary tract infections (UTIs). The client asks the PN how to prevent these infections from reoccurring. What information should the PN give to this client? (Choose all that apply.)

Take all of the prescribed antibiotic. Void before and after sexual intercourse. Wipe from front to back after voiding.

A client with a history of epilepsy is admitted for back pain related to the presence of a cyst located at T6. The client has a tonic-clonic (grand mal) seizure and 30 minutes later is incontinent of urine. What is the priority action for the practical nurse to implement?

Have the client push both feet against the nurse's hands.

A female client arrives at the clinic holding her abdomen and reports diffuse abdominal pain and a frothy greenish vaginal discharge. What intervention is most important for the practical nurse (PN) to implement?

Check urine with early pregnancy test.

An older male resident of an extended care facility, who had no obvious injuries after a fall a couple of weeks earlier, has become increasingly confusion over the last 4-5 days. Which complication should the practical nurse suspect as a result of the recent fall?

Chronic subdural hematoma.

A male client with type 1 diabetes mellitus comes to the clinic because he is feeling bad. He tells the practical nurse (PN) that he stopped taking his prescribed insulin. He has a flushed appearance; a deep, sighing respiratory pattern; and a fruity breath odor. Which action should the PN implement?

Prepare regular insulin dose based on blood glucose results.

A male client who arrives at the clinic for an eye examination tells the practical nurse (PN) that he has recently experienced blurred vision. Which finding is most important for the PN to report to the healthcare provider?

Small rapid, rhythmic, oscillating movements of eyeballs.

An adult male presents in the Emergency Center with "tearing" chest pain that has moved into his back. Which finding by the practical nurse in the client's history is relevant to the client's chest pain?

Smokes three packs of cigarettes a day.

When making morning assessments, the practical nurse finds a client who is exhibiting a new finding of right-sided facial drooping. Which assessment is most important for the PN to implement first?

Test all four extremities for movement and strength.

A female client who is postmenopausal calls the clinic and states that she has been spotting for the last three days. What action should the practical nurse (PN) implement?

Tell the client to come to the clinic today.

The practical nurse (PN) obtains an oral temperature of 100F (37.8C) for a female client who is one day postoperatively after a total abdominal hysterectomy. What action should the PN implement?

Evaluate the client's temperature in 4 hours.

A client with a headache, fever, and stiff neck is admitted with the diagnosis of bacterial meningitis. Which prescription should the practical nurse administer first?

Ceftriaxone (Rocephin).

The practical nurse (PN) is caring for a client who returns to the room after a bronchoscopy with a local anesthetic. What action should the PN take prior to giving the client a lunch tray?

Check presence of a gag reflex.

A client who is a competitive athlete returns from the operating room after having an open reduction and internal fixation of the right tibia. The practical nurse (PN) determines the client's apical heart rate is 48 and regular. Which action should the PN perform next?

Observe the clients level of consciousness.

A client who is experiencing an acute asthma attack is receiving rescue medication. The practical nurse (PN) reviews the client's history to determine the client's respiratory function over the past few months. Which device results should the practical nurse review to obtain data that measures the client's personal best respiratory function?

Peak flow meter.

A client with a peptic ulcer develops severe upper abdominal pain. Which finding is most important for the practical nurse (PN) to report to the charge nurse?

Rigid, board-like abdomen.

The practical nurse (PN) is caring for a male client who is in the rehabilitation unit following an acute brain attack (cerebral vascular accident (CVA) or stroke). The PN notes that the client eats food from only the right side of the plate. Which action should the PN take?

Teach to turn head to scan visual areas