NCLEX LPN Physiological Adaptation 1
The LPN/LVN expects the client to experience which of the following physiological changes during episodes of acute pain? 1. Decreased blood pressure. 2. Decreased skin temperature. 3. Decreased heart rate. 4. Decreased respiration.
Strategy: Think about each answer. (1)blood pressure and heart rate increase, which increases blood flow to brain and muscles (2)CORRECT—increased perspiration and vasoconstriction occur during acute pain episodes, thereby cooling off the skin (3)heart rate increases, resulting in increased cardiac output to meet the need for increased oxygen (O2) (4)rapid, irregular respirations lead to increased oxygen supply to brain and muscles
The nurse cares for a client diagnosed with spinal cord injury at the level of T1. The nurse notes profuse sweating, and the client complains of a pounding headache and nasal stuffiness. Arrange the following actions in the proper sequence from FIRST to LAST. All options must be used immediately. Instruct the client about how to prevent autonomic dysreflexia: instruct about signs/symptoms and causes (full bladder, impaction, pressure on skin, cool draft) Place the client in a sitting position: lowers blood pressure immediately Check the Foley catheter tubing for kinks or obstruction: most common cause is distended bladder or constipation Label the chart with a visible note about the risk for autonomic dysreflexia: ensures that staff is aware of risk Monitor the blood pressure every 10-15 minutes: if emptying the bladder or removing the fecal mass does not decrease blood pressure, hydralazine hydrochloride (Apresoline) is administered IV
Strategy: Determine how best to decrease client's blood pressure. (1) Place the client in a sitting position: lowers blood pressure immediately (2) Check the Foley catheter tubing for kinks or obstruction: most common cause is distended bladder or constipation (3) Monitor the blood pressure every 10-15 minutes: if emptying the bladder or removing the fecal mass does not decrease blood pressure, hydralazine hydrochloride (Apresoline) is administered IV (4) Label the chart with a visible note about the risk for autonomic dysreflexia: ensures that staff is aware of risk (5) Instruct the client about how to prevent autonomic dysreflexia: instruct about signs/symptoms and causes (full bladder, impaction, pressure on skin, cool draft)
The LPN/LVN teaches an adult wellness class about how to prevent skin cancer. Which of the following statements by the LPN/LVN is BEST? 1. "Wear sunscreen if the temperature is above 80.0°F (26.7°C)." 2. "Wear a hat during the summer months." 3. "Stay indoors 11 AM-3 PM." 4. "Examine your body daily for any change to size and color of skin lesions."
Strategy: "BEST" indicates discrimination is required to answer the question. (1) wear sunscreen when going outdoors regardless of the temperature (2) wear hat and sunglasses when out in the sun (3) CORRECT—exposure to the sun is a major risk factor to developing skin cancer; wear sunscreen that is appropriate to a person's skin (4) examine body monthly; report any changes to health care provider
The LPN/LVN understands that bedrest following a myocardial infarction (MI) BEST achieves which of the following? 1. Facilitates accurate cardiac monitoring. 2. Promotes a restful atmosphere. 3. Decreases the workload on the heart. 4. Allows regeneration of the myocardium.
Strategy: "BEST" indicates discrimination may be required to answer the question. (1) accurate cardiac monitoring can be achieved if client is ambulatory (2) a calm environment will decrease anxiety, which will help relieve chest pain (3) CORRECT—client has altered cardiopulmonary tissue perfusion caused by MI; bedrest during the 24 h will decrease the workload of the heart by reducing myocardial oxygen consumption (4) cellular regeneration does not occur in cardiac tissue; scar tissue forms
The LPN/LVN auscultates a client's breath sounds. The LPN/LVN knows that vesicular sounds will have which of the following characteristics? 1. Loud, coarse, blowing sound heard over the trachea. 2. Musical sounds or vibration commonly heard on expiration. 3. Harsh sounds heard over the mainstem bronchi. 4. Soft and low-pitched breezy sounds heard over most of the peripheral lung fields.
Strategy: Think about each answer. (1)describes bronchial breath sounds; normal sounds (2)describes rhonchi; adventitious sounds caused by fluid or inflammation (3)describes bronchovesicular sounds; normal sounds (4)CORRECT—describes vesicular sounds, normal sounds
The home care LPN/LVN monitors a client diagnosed with cancer of the lung. The client states that she has awakened with a severe headache several mornings during the past week. She also admits to becoming suddenly nauseated, has vomiting, and notices that she is drooling. Which of the following actions by the LPN/LVN is BEST? 1. Administer the prescribed antiemetic. 2. Reassure the client that this is expected. 3. Assess the status of the client's lungs. 4. Contact the supervising nurse.
Strategy: "BEST" indicates that discrimination is required to answer the question. (1)manifestations indicate the possibility of metastasis to the brain; LPN/LVN should contact the supervising nurse (2)indicates a complication of lung cancer and should be reported immediately (3)should perform neurological assessment (4)CORRECT—should perform neurological assessment and contact the supervising nurse
A father is concerned about his son's detached retina. He asks the LPN/LVN if a retinal detachment can be hereditary. The BEST response by the LPN/LVN includes which of the following? 1. "Have any of your other children had a detached retina?" 2. "There are no certain causes of retinal detachment." 3. "The cause of his retinal detachment was severe trauma." 4. "We should focus on preventing it from happening again."
Strategy: "BEST" indicates that discrimination is required to answer the question. (1.) caused by trauma, aging process, diabetes, and tumors (2.) CORRECT—this is the best response the LPN/LVN can give the boy's father because there are no certain causes of retinal detachment; a number of factors may contribute, including trauma, aging, diabetes, and tumors; has been found that clients who have a family history of retinal detachment or other ocular diseases are more prone to retinal detachment, but is not a hereditary disease (3.) no information given to support trauma (4.) since cause is unknown, no way to know how to prevent
A nursing assistant tells the LPN/LVN that a client is having an allergic reaction to the IV medication administered 5 minutes ago. Which of the following actions should the LPN/LVN take FIRST? 1. Administer Benadryl 50 mg PO stat. 2. Place Code Blue cart at the bedside. 3. Locate the supervising nurse. 4. Assess the status of the client.
Strategy: "FIRST" indicates priority. (1) drug may be administered orally if reaction is mild; would need to assess client prior to administering (2) need more information before deciding client may be at risk for anaphylaxis; epinephrine may be administered to relax bronchial smooth muscles (3) client is at risk for a life threatening health alteration; should ask nursing assistant to locate supervising nurse; should go directly to the client's room (4) CORRECT—immediately go to the client's beside and perform an assessment
The LPN/LVN on the surgical unit cares for a client after an ileostomy. Which of the following actions should the LPN/LVN take FIRST? 1. Empty the ileostomy bag from the bottom. 2. Apply lotion to the skin around the stoma. 3. Cover the ileostomy with three layers of gauze. 4. Evaluate the output and record it in the chart.
Strategy: "FIRST" indicates priority. (1) implementation; empty the pouch when it is 1/3 to 1/2 full; should monitor the characteristics frequently (2) implementation; skin barrier required due to proteolytic enzymes and bile salts that are present in the stool; do not use moisturizers, prevents good seal around stoma (3) implementation; drainage from ileostomy is very irritating to the skin; unlike colostomy, it requires constant wearing of pouch; gauze will not protect the skin (4) CORRECT— assessment; output from the ileostomy is liquid and may be copious; important to assess client's intake and output
The LPN/LVN cares for the client receiving magnesium sulfate IV. The LPN/LVN notes that the client's deep tendon reflexes are decreased from +1 to 0. Which action should the LPN/LVN take FIRST? 1. Document the results in the patient's chart. 2. Place the call light within reach of the patient. 3. Dim the lights prior to leaving the room. 4. Clamp the magnesium IV infusion.
Strategy: "FIRST" indicates priority. (1) magnesium sulfate given to prevent and treat convulsions; decreased deep tendon reflexes indicates magnesium toxicity; stop the magnesium to prevent further decline (2) appropriate action, but would not be the first action; pad side rails, keep oxygen equipment available (3) want a quiet, nonstimulating environment; do not leave the client (4) CORRECT loss of reflexes or respiratory depression sign of magnesium toxicity, which may cause respiratory or cardiac arrest; discontinue infusion, contact physician, keep calcium gluconate at bedside
The nurse enters the client's room during a blood transfusion. The LPN/LVN should attend to which of the following sign/symptom FIRST? 1. Blood pressure 145/80 mm Hg. 2. The client complains of shortness of breath. 3. The client complains of pruritus. 4. Hemoglobinuria.
Strategy: "FIRST" indicates priority. (1) transfusion reactions usually cause hypotension; borderline systolic elevation is considered to be related to psychological stress (2) CORRECT—dyspnea may indicate an allergic reaction with a decrease in caliber of the trachea, which signals an immediate life-threatening risk to the client's health; may also indicate circulatory overload; place client in upright position, stop the transfusion, keep IV patent with very slow infusion of IV normal saline (3) indicates allergic reaction, but not immediately life-threatening (4) hemoglobin is excreted in the urine and indicates hemolytic reaction caused by ABO incompatibility; is extremely life-threatening but the dyspnea needs to be addressed FIRST
The LPN/LVN assists in the teaching of a client diagnosed with asthma. The LPN/LVN determines that further teaching is necessary if the client states which of the following? 1. "I'm going to have to replace my wool rugs and feather pillows." 2. "I can no longer rake the leaves or garden like I used to." 3. "We are going to have to dust and vacuum more frequently." 4. "I'm going to have to establish a regular bedtime routine."
Strategy: "Further teaching is necessary" indicates incorrect information. (1) will remove allergens that can trigger an asthmatic attack (2) true statement; can trigger an allergic reaction; should avoid smoke, fireplaces, dust, mold, and weather changes (3) appropriate behavior; should also avoid medications that can trigger asthma, such as aspirin and nonsteroidal anti-inflammatory drugs, and foods prepared with monosodium glutamate (4) CORRECT—this is a good health habit but will not prevent or control "triggering" of an asthma attack
The LPN/LVN cares for a client diagnosed with colorectal cancer. The LPN/LVN understands that eating which of the following foods may have contributed to the client developing colon cancer? 1. Broccoli and cabbage. 2. Fried red meat. 3. Water. 4. Oranges and grapefruit.
Strategy: Think about each answer. (1)food from cabbage family should be consumed to decrease the incidence of colon cancer (2)CORRECT—contributes to the risk of developing colon cancer; other foods to avoid include animal fats, broiled meats and fish, and concentrated sweets (3)adequate amount of water is desirable (4)fruits and vegetables are desirable
An elderly client is lost in the mountains for 3 days, and after rescue is admitted to the unit with a diagnosis of dehydration. In addition to monitoring for signs and symptoms of dehydration, it is MOST important for the LPN/LVN to monitor for which of the following? 1. Elevated blood pressure. 2. Peripheral edema. 3. Cardiac dysrhythmias. 4. Depression.
Strategy: "MOST important" indicates priority. (1) fluid volume deficit causes hypotension, rapid and weak pulse, and an elevated temperature; cardiac dysrhythmias are more significant safety risks to the client (2) more common in fluid volume excess (3) CORRECT—because of cellular breakdown during severe dehydration, lactic acid is released, resulting in signs/symptoms of metabolic acidosis, which results in cardiac dysrhythmias and change in mental status; the decreased pH results in decreased contractility and inotropic response to decreased catecholamine secretion (4) helping client manage the emotional response to being lost for several days should be integrated into nursing care; need to focus on physical stability first
The LPN/LVN identifies which of the following risk factors as MOST likely to contribute to an elevation of client's blood pressure? 1. A high-pressure job. 2. Daily vitamins. 3. One glass of wine a day. 4. Daily exercise.
Strategy: "MOST likely" indicates that discrimination is required to answer the question. (1)CORRECT—stress is an important factor in the development of hypertension; other risk factors include family history of hypertension, high sodium intake, and excessive calorie consumption (2)a diet rich in fruits, vegetables, and whole grains helps prevent development of hypertension (3)excessive alcohol intake is a risk factor for hypertension; small amount of wine per day is believed to lower or prevent hyperlipidemia (4)helps prevent hypertension
The LPN/LVN identifies that which of the following clients is MOST likely to develop seizures? 1. The client who is allergic to shellfish. 2. The client who leads a sedentary lifestyle. 3. The client who has a brain tumor. 4. The client who is 62 years old.
Strategy: "MOST likely" indicates that discrimination is required to answer the question. (1.) more likely to experience cardiovascular shock (2.) may result in inability to respond to sudden increase in physical activity or response to sustained emotional stress; respiratory and cardiovascular reserve are likely to be minimal (3.) CORRECT—more likely to occur when conditions disrupt rhythmic electrical impulses in the brain; a localized organic lesion is more likely to cause disruption than the others listed (4.) a seizure disorder is not an age-related disorder; older adults often present with seizure disorders after a stroke
The LPN/LVN understands that which of the following is the MOST significant risk factor for developing cancer? 1. Advancing age. 2. Smoking tobacco. 3. Drinking alcohol. 4. Family history of cancer.
Strategy: "MOST significant" indicates that discrimination is required to answer the question. (1)CORRECT—single most significant risk factor; 50% of all cancers occur in people older than 65 years of age (2)tobacco is a carcinogen that contributes to lung, pharyngeal, esophageal, cervical, bladder, pancreatic, and kidney cancer (3)alcohol contributes to cancer of the liver; alcohol and tobacco enhance the carcinogenic activity of each other (4)some cancers have a genetic predisposition
The LPN/LVN contributes to the care for a client admitted to the emergency room after an automobile accident. The client complains of dizziness, and the health care provider suspects a head injury. The LPN/LVN should intervene if which of the following is observed? 1. The client leans forward with his head over his knees. 2. The client's neck is immobilized before being x-rayed. 3. The family members ask to remain with the client. 4. The nursing assistant sets up seizure precautions.
Strategy: "Should intervene" indicates something is wrong. (1.) CORRECT—clients with head injuries are treated as spinal cord injuries until x-rays are completed; need to obtain assistance to immobilize the client's neck should come before x-rays (2.) clients with head injuries are treated as spinal cord injuries until x-rays are completed; need to obtain assistance to immobilize the client's neck should come before x-rays (3.) clients are often comforted by the presence of family members; agitation should be kept to a minimum (4.) due to cerebral irritation, seizures often accompany head trauma
The LPN/LVN contributes to the teaching about home care instructions for a client diagnosed with angina. The LPN/LVN determines teaching is effective if the client makes which of the following statements? 1. "If I have chest pain, I should contact my physician immediately." 2. "If I have chest pain, I should stop my activity and take a nitroglycerin tablet." 3. "I can take another nitroglycerin tablet if chest pain doesn't subside in 30 minutes." 4. "If I have chest pain, I should rest for 30 minutes and then take a nitroglycerin tablet."
Strategy: "Teaching is effective" indicates accurate information. (1) contact physician if chest pain hasn't been relieved by nitroglycerin, 1 tablet at 5 min interval x 3; physician often difficult to reach; if reached cannot offer appropriate assistance by phone; need to seek emergency medical assistance (2) CORRECT—angina is chest discomfort caused by the heart's inability to provide oxygen to the cardiac muscle; warning sign of ischemia; anginal pain is relieved by rest and nitroglycerin; the client should first rest and immediately take a nitroglycerin tablet (3) time period is too long; client should lie down, put nitroglycerin tablet under the tongue, and wait 5 min to see if pain relieved; if not put another nitroglycerin tablet under the tongue and wait 5 min; if pain not relieved, repeat one more time (4) stop activity and immediately place nitroglycerin under tongue; if possible should communicate to someone in the area, is having chest pain
The LPN/LVN assists in the assessment of a client who sustained burns in an apartment fire. The LPN/LVN should IMMEDIATELY report to the supervising nurse which of the following signs/symptoms? 1. The client has singed nasal hair. 2. The client's blood pressure is 106/62 mm Hg. 3. The client has blisters on her hands. 4. The client's capillary refill time is <3 seconds.
Strategy: Determine how each answer relates to burns. (1) CORRECT—intra-oral burns and singed nasal hairs indicate potentially serious injuries to respiratory system; should be observed for progressive hoarseness, brassy cough, drooling or exhibiting difficulty swallowing, crowing, wheezing, or stridor (2) within normal limits for minimal support of body function; would need to monitor closely for shock (3) indicates deep partial thickness burns; client may have burns of various thickness (4) within normal limits; as tissue perfusion decreases, capillary refill time may become more sluggish or absent
When the LPN/LVN delivers external cardiac compressions during cardiopulmonary resuscitation, it is MOST important for the LPN/LVN to take which of the following actions? 1. Maintain a position close to the victim's side with the knees apart. 2. Maintain vertical pressure through the heel of the hand. 3. Recheck the hand position after every 10 compressions. 4. Check for a return of the pulse after every 8 breaths.
Strategy: Determine the outcome of each answer. Is it desired? (1) one rescuer—face victim, on knees, parallel to victim's sternum; two rescuers—one person faces victim kneeling parallel to victim's head, second person on opposite side facing victim, kneeling parallel to victim's sternum (2) CORRECT—for cardiac compressions to be efficient and effective, there should be vertical pressure through the heel of the hand with each compression; only the heel of the hand should be placed on the sternum; the shoulders should be parallel to the sternum and elbows should be locked to generate enough pressure for even a small person to move the sternum 1.0 to 1.5 inches downward, and compress the heart between the sternum and the vertebrae (3) do not apply compression over the xiphoid process (4) perform 4 cycles of compressions and ventilations for an adult, 20 cycles for an infant, and then reassess pulse and breathing
The LPN/LVN assists with the discharge teaching for a client diagnosed with chronic obstructive pulmonary disease (COPD). When the client's wife asks why the concentration of the supplemental oxygen cannot be increased when the client is having difficulty breathing, the MOST appropriate response by the LPN/LVN should be based on which of the following? 1. High-flow oxygen interferes with breathing. 2. Low-flow oxygen will not improve breathing. 3. High-flow oxygen will stimulate breathing. 4. Low-flow oxygen is more comfortable.
Strategy: Think about each answer. (1) CORRECT—progressive loss of recoil of lung tissue results in air trapped in the lung tissue as well as an arterial hypercapnia;hypoxemia stimulates the client to breathe; sudden increase of oxygen (O2) in the blood can decrease this stimulus, which would suppress the respiratory drive;recommended that clients receive constant low oxygen (O2) of 1-2 L/min (2) low-flow oxygen (O2) will not interfere with client's stimulation to breathe (3) decreases stimulation to breathe (4) dyspnea would decrease, resulting in greater comfort, but this is not primary reason for administering low-flow oxygen (O2)
The LPN/LVN cares for a client admitted to the unit with a diagnosis of acute myocardial infarction. The LPN/LVN identifies this client is attached to a cardiac monitor for which of the following reasons? 1. To monitor client's condition closely without being disturbed during sleep. 2. To prevent another, more serious heart attack from occurring. 3. To verify diagnosis of acute myocardial infarction. 4. To detect any life-threatening changes in the heart rhythm.
Strategy: Think about each answer. (1) does promote rest by providing assessment data by way of mechanical assessment; rest is important but is not the most relevant rationale for monitoring the client's cardiac status; early detection is the key to MI recovery (2) monitoring can identify dysrhythmias but can't prevent another MI; could detect problems early, resulting in management to prevent further damage or alteration (3) symptoms of MI include chest pain, dyspnea, nausea, vomiting, gastric discomfort, apprehension, acute pulmonary edema, or shock; change in ECG pattern can indicate whether or not MI has occurred, but does not confirm when the damage/alteration occurred; the MOST definitive diagnostic tool includes elevated CK levels or other cardiac enzymes (4) CORRECT—cardiac monitor is a continuous assessment tool that reveals the client's heart rhythm and electrical patterns; immediately provides feedback regarding any abnormalities such as PVC or ventricular fibrillation
The LPN/LVN recognizes that which of the following is an early symptom of gastric cancer? 1. Occult blood in the stool. 2. Vomiting. 3. Iron-deficiency anemia. 4. Abdominal discomfort relieved with antacids.
Strategy: Think about each answer. (1) indicates advanced gastric cancer (2) indicates advanced gastric cancer (3) indicates advanced gastric cancer (4) CORRECT—other indications include indigestion, loss of appetite, bloated feeling, and weight loss
An elderly client has a medical history that includes hypertension. A public health LPN/LVN visits the client regularly and on each visit records the vital signs. Which of the following findings does the LPN/LVN expect for this client? 1. Temperature 99.9 F (37.7°C), blood pressure 150/90 mm Hg, pulse 90, respirations 20. 2. Temperature 99.5 F (37.5°C), blood pressure 140/80 mm Hg, pulse 110, respirations 32. 3. Temperature 98.6 F (37°C), blood pressure 120/80 mm Hg, pulse 78, respirations 16. 4. Temperature 96.8 F (36°C), blood pressure 160/90 mm Hg, pulse 80, respirations 24.
Strategy: Think about each answer. (1) temperature too high (2) temperature and pulse too high (3) blood pressure usually higher with hypertension (4) CORRECT—in the elderly, body temperature may decrease; temperature is normal for elderly client; blood pressure of 160/90 mm Hg would be expected in a client who has a medical history of hypertension, but is not receiving antihypertensive/s; pulse of 80 normal; respirations of 24 normal
The LPN/LVN identifies that which of the following findings are characteristic of a client with chronic pain? 1. Weight loss or gain, fatigue. 2. Obesity, restlessness, and thirst. 3. Anxiety, insomnia, and memory loss. 4. Quick response to analgesics.
Strategy: Think about each answer. (1)CORRECT—chronic pain is an episode of pain that lasts for 6 months or more; serves no useful function and becomes a problem of its own; chronic pain often becomes a disability; in some clients, weight loss occurs because of inadequate caloric intake with an increased metabolic rate; some gain because they eat but are unable to exercise; fatigue evolves because of the constant drain on the body's energy stimulated by the sympathetic response to the pain process (2)weight gain occurs because of the reduced activity; restlessness and thirst are outcomes of the sympathetic response to the pain experience (3)constantly dealing with the discomfort of pain interferes with sleep, results in anxiety related to constant anticipation of pain; inadequate rest and sustained discomfort can interfere with cognitive functioning; could also occur with acute pain. (4)chronic pain may be diffuse, not localized, and difficult to describe
The LPN/LVN cares for a client diagnosed with leukemia. The client tells the LPN/LVN that he is having abdominal pain. The LPN/LVN understands that the abdominal pain is due to which of the following? 1. Hepatosplenomegaly. 2. Side effects of medication. 3. Persistent vomiting. 4. Intra-abdominal bleeding.
Strategy: Think about each answer. (1)CORRECT—clients with leukemia develop enlarged liver and spleen, causing the abdominal pain (2)side effects of chemotherapy include bone marrow depression, alopecia, and nausea and vomiting (3)may occur due to chemotherapy; administer an antiemetic (4)decreased platelet count may cause hematuria and bleeding from gums
The LPN/LVN knows that which of the following laboratory findings reflects the signs and symptoms of infection? 1. Serum creatinine level of 2.4 mg/dL. 2. AST (SGOT) 15 U/L. 3. White blood cell count of 16,000/mm3. 4. White blood cell count of 4,000/mm3.
Strategy: Think about each answer. (1)measures renal function; normal is 0.5 to 1.5 mg/dL; elevated in acute and chronic renal failure (2)measures damage to liver and heart; normal is 10 to 40 U/L (3)CORRECT—normal range is 4,500 to 11,000/mm3; elevation indicates infection (4)indicates client becoming immunosuppressed
A client with ovarian cancer experiences severe pain. Which of the following principles should the LPN/LVN apply? 1. Caution must be used to prevent narcotic addiction. 2. Cancer pain is often psychological in origin. 3. Pain medication should be given only with evidence of severe pain. 4. Pain medication is more effective if given before pain becomes severe.
Strategy: Think about each answer. (1)primary focus in the management of clients with pain related to terminal illness is narcotic tolerance rather than addiction (2)all pain is real; pain is "whatever the person experiencing the pain says it is"; goal is to increase the level of comfort; source of pain experience is unknown (3)preventive approach is preferable; requires smaller doses of medication to relieve or prevent pain if medication is given regularly; prevention allows the client to spend less time in pain and prevents addiction (4)CORRECT—pain medication given before the peak of severity is more effective in managing the pain
The LPN/LVN cares for a child experiencing grand mal seizures. The LPN/LVN attempts to identify the "aura" of a child with grand mal seizures. The LPN/LVN identifies which of the following statements as BEST describing an "aura"? 1. A state of consciousness during the convulsive attack. 2. Unusual sensations before the seizure attack. 3. Emotional status of client after the seizure attack. 4. Uncomfortable feeling as the seizure begins to subside.
Strategy: Think about each answer. (1.) unconsciousness occurs during generalized seizures and complex partial seizures due to excessive discharge of electrical activity within the brain (2.) CORRECT—an "aura" can be described as a series of unusual sensations that occur BEFORE the seizure; occurs in about 50% of all seizure clients; the character of the aura varies from person to person; may include numbness, flashing lights, dizziness, smells, and spots before the eyes (3.) postictal phase; aura is often warning that seizure is about to occur (4.) level of consciousness is not re-established at this time; aura occurs while client is fully conscious
To measure the pulse during adult cardiopulmonary resuscitation (CPR), the LPN/LVN should use which of the following arteries? 1. The femoral artery. 2. The radial artery. 3. The carotid artery. 4. The brachial artery.
Strategy: Think about the location of each artery. (1) located below inguinal ligament, midway between symphysis pubis and anterior superior iliac spine; assess status of circulation to leg (2) found on thumb side of forearm at wrist; used to assess peripheral pulse (3) CORRECT—carotid artery is most accessible; if there is a weak pulse, it will most likely be felt in the carotid artery (4) found in groove between biceps and triceps muscles at antecubital fossa; used if performing CPR on infant
The LPN/LVN understands that psoriasis is which of the following? 1. A chronic hereditary disease. 2. An acute infectious disease. 3. A viral disease. 4. A cystic, self-limiting disease.
The LPN/LVN understands that psoriasis is which of the following? 1. A chronic hereditary disease. 2. An acute infectious disease. 3. A viral disease. 4. A cystic, self-limiting disease.
