PNR206 Med Surg Hesi
Which action should the practical nurse (PN) implement to reduce the risk of infection for a client who is receiving total parenteral nutrition (TPN)?
Change the transparent dressing every 72 hours.
The practical nurse (PN) auscultates the abdomen of a client who had a barium swallow 24 hours ago and determines the client has decreased bowel sounds. The client reports having no bowel movements for 2 days. Which nursing intervention should the PN implement?
Check digitally for a bowel impaction.
A client with newly diagnosed essential hypertension is learning to cope with stressful situations in his life. Which activity should the practical nurse (PN) implement to help the client learn constructive coping?
Role play a situation the client identifies as stressful.
The practical nurse (PN) is caring for a client with a chest tube connected to a closed chest drainage system to suction at 20 cm of water pressure. The sterile water in the suction chamber is gently bubbling at the water level of 15 cm. What action should the PN take?
Add sterile water to the suction control chamber to the 20 cm mark.
After receiving report, the practical nurse (PN) begins assessment for a client with chronic obstructive pulmonary disease (COPD) who has just completed a respiratory treatment. The PN finds the client sitting upright in bed with oxygen at 6 liters/minute per nasal cannula. Which intervention is most important for the PN to implement?
Decrease oxygen flow rate to 2 liter/minute and attach pulse oximeter.
Which information should the practical nurse (PN) reinforce with a client with a tracheostomy who is learning self-feeding?
Tilt the chin forward toward the chest when swallowing.
A client with epilepsy is having bilateral rhythmic jerking movements of all extremities. After calling for help, which action should the practical nurse (PN) do next? (Arrange the interventions from first to last.)
1. Maintain the client's airway2. Apply pads to the bedside rails.3. Avoid stimulation during post-ictal phase.4. Observe the client for incontinence
Which client should the practical nurse question a PRN prescription for sumatriptan (Imitrex) for migraine headaches?
50-year-old with Prinzmetal's angina.
A practical nurse (PN) is coordinating the care of four clients on an oncology unit. Which neutrophil count should the PN identify as a risk for a life-threatening infection in one of the clients?
500/mm3.
The practical nurse (PN) is reinforcing information to a older male client with a history of coronary artery disease about his prescribed daily medication regimen. Which medication is most likely to reduce the client's risk factors?
A low-dose aspirin given daily.
A male client receives the negative results for his recent fecal occult blood test and calls the clinic to cancel his colonoscopy scheduled for the next day. Which information should the practical nurse provide?
A negative result for occult blood does not rule out lesions in the colon.
A client with major burns is receiving cimetidine (Tagamet). Which finding should the practical nurse (PN) obtain to best evaluate the effectiveness of the medication?
Absense of blood in the stool.
A 60-year-old client with benign prostatic hyperplasia (BPH) has been up to the bathroom six times during the night. The client asked the practical nurse (PN) if there is something the healthcare provider can do to help him with this problem before he has a transurethral resection of the prostate (TURP). What information should the PN offer?
An indwelling catheter is sometimes prescribed to alleviate symptoms.
Which client should the practical nurse consider at greatest risk for bacterial cystitis?
An older female who does not use estrogen replacement.
An adult male who is covered with "road rash" after falling off his bicycle arrives at the clinic. He holds his hand to his chest and tells the practical nurse (PN) that he hurts when he breathes. The PN hears an audible "slurping" sound each time the client takes a breath. Which intervention should the PN implement first?
Apply oxygen and inspect the chest wall.
A male client returns to the surgical nursing unit after having a thyroidectomy. Which action is most important for the practical nurse to implement?
Assess the client's respiratory status.
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/minute. During the bed bath, the client complains of shortness of breath. Which action should the practical nurse (PN) implement?
Assist the client into a Fowler's position.
The practical nurse (PN) is reviewing the health history of a client with coronary artery disease (CAD). Which finding should the PN identify that places the client at risk for stroke?
Atrial fibrillation.
Which instruction should the practical nurse (PN) reinforce with a female client about skin care after her first radiotherapy treatment?
Avoid using ice packs on the exposed area.
Which information should the practical nurse (PN) offer a female client who is at risk for recurrent urinary tract infection (UTI)? (Select all that apply.)
Avoid wearing tight-fitting jeans.C. Limit caffeine and alcohol.D. Void before and after intercourseE. Wipe the perineum from front to back.
Which findings should the practical nurse identify in a client with anemia due to a vitamin B 12 deficiency?
B. Smooth, beefy-red oral cavity.D. Paresthesia of hands and feet
A client is admitted with a C4 spinal cord injury (SCI) after falling from a roof at a construction site. After returning to the unit for a CT scan to confirm the vertebral fracture, which assessment by the practical nurse has the highest priority?
Check the respiratory effort and pulse oximeter reading.
The practical nurse is caring for a client who is admitted with signs of possible acute brain attack (Stroke) three hours ago. The client's blood pressure is 170/96, regular radial pulse 76 beats/minute, respirations are nonlabored at 11 breaths/minute, and a Sp02 of 99%. What action is most important for the PN to implement?
Continue to monitor client's blood pressure.
A client with Parkinson's disease asks the practical nurse (PN) to explain how this disease causes his muscles to malfunction. Which underlying pathophysiology should the PN use as a basis for the explanation?
Degeneration of the basal ganglia leads to a decrease in dopamine levels.
What information should the practical nurse (PN) reinforce with a client who is recently diagnosed with diabetes mellitus (DM)?
Diabetes increases the risk for cardiovascular disease.
Which finding for a client with heart failure (HF) should the practical nurse (PN) report to the charge nurse?
Distended neck veins while upright.
The practical nurse (PN) is visiting a male client with diabetes who has a new cast on his arm. The client's fingers are pale, cool, slightly swollen, and the radial pulse is strong. What should the PN do first?
Elevate the arm above the level of the heart.
The practical nurse (PN) is reviewing the admission laboratory results for a client with cirrhosis of the liver. Which finding should the practical nurse (PN) report to the healthcare provider?
Elevated serum ammonia
A client who received graphs for a full-thickness burn of the right arm is admitted to the rehabilitation unit. Which action is important for the practical nurse to reinforce with the client to prevent long-term complications?
Exercise the affected arm everyday.
Which behavior demonstrates hopelessness in an older client with a terminal disease?
Failing to follow medical recommendations.
Which intervention is most important for the practical nurse to implement after giving a client an initial injection for the screening for allergies?
Have the client remain on-site for 30 minutes after the injections.
Which finding should the practical nurse (PN) identify as typical for a client who is hypoxic?
Hemoglobin of 10 grams/dl
Which finding for a client who is 1-day postoperative for a partial thyroidectomy requires immediate follow-up by the practical nurse (PN)?
High pitched expiratory sound.
The practical nurse (PN) is obtaining deep tendon reflexes for a client with type 1 diabetes mellitus. Which finding indicates to the PN that the client has peripheral neuropathy?
Hypoactive reflexes at the Achilles tendon
Which actions should the practical nurse implement for a client whose fractured tibia is causing swelling of the lower leg?
Ice application and elevation.
A male client is one day postoperative for surgical repair of a fractured femur when he suddenly experiences dyspnea, coughing, chest pain, and hemoptysis. Based on this data, what nursing diagnoses should the practical nurse address for this client?
Impaired gas exchange related to altered blood flow to alveoli
The practical nurse (PN) is reviewing laboratory results for a client admitted with possible meningitis and identifies that the cerebrospinal fluid (CSF) findings are positive for bacteria. Which action is most important for the PN implement?
Implement droplet precautions
Which action should the practical nurse take when handling a sample of cerebrospinal fluid (CSF) collected for diagnostic testing from a client?
Implement standard precautions with the CSF specimen.
What complication is most important for the practical nurse to monitor for in a client who has a total hip replacement?
Infection
A client's results for this morning's platelet count is 30,000/mm 3 . What action should the practical nurse (PN) implement first?
Institute bleeding precautions.
An older female client with osteoporosis asks the practical nurse (PN) to explain why she is now 2 inches shorter than when she was younger. What information is best for the practical nurse (PN) to provide?
It is a combination of wear and tear and calcium loss that causes the change.
An older male client with osteoarthritis complains of stiffness and pain in his hips, knees, and feet each morning and asks the practical nurse (PN) why just these joints bother him. Which explanation should the PN provide?
Joint damage can occur from years of weight-bearing stress.
A male client is admitted with lower right abdominal pain for the past two days. During the focused assessment, the practical nurse (PN) observes that the client's abdomen is rigid with tense positioning. Which action should the PN implement?
Keep the client NPO for possible surgery.
The practical nurse (PN) is reviewing the side effects associated with chlopromazine (Thorazine) rectal suppository for a client with nausea and vomiting. Which information should the PN review with the client?
Minimize exposure to sunlight during therapy.
A client is scheduled for a transurethral resection of the prostate (TURP). What statement by the client reveals to the practical nurse that the client needs additional information?
My incision will probably be painful.
A client who has vomiting, dysuria, and urinary tract infection (UTI) arrives in the clinic and receives an IV antiemetic and a liter of IV fluids. The healthcare provider prescribes oral antibiotics for the client's discharge. Which finding is essential for the practical nurse to determine before the client is discharged?
No vomiting with oral fluid intake.
A male client with a crushing injury of the right lower leg from a tractor accident complains of numbness and tingling in his right leg and foot. The practical nurse (PN) determines the right leg is pale and he has a weak pedal pulse. What action should the PN take?
Notify the healthcare provider.
Which assessment is most important for the practical nurse (PN) to implement for a client who returns from surgery for an arthroscopic repair of the right knee?
Palpation of both pedal pulses.
Which client medical diagnosis is a contraindication for peritoneal dialysis in a client with chronic renal failure?
Peritonitis
The practical nurse (PN) is performing a shift assessment of a client with a fractured left hip that occurred in a motor vehicle collision 36 hours ago. Which finding should the PN report to the charge nurse?
Pinpoint rash on upper chest that does not blanch.
A client arrives at the oncology clinic for the next treatment in the prescribed course of chemotherapy (CT). The practical nurse (PN) reviews the client's laboratory results: white blood cells 700/mm 3 , red blood cells 2.8 million/mm 3 , hemoglobin 7.9 grams/dl, hematocrit 25.5%, and platelet count 14,000/mm 3 . Which action should the PN take first?
Place an isolation mask on the client.
Which factor should the practical nurse (PN) identify that indicates a client needs to be screened for an aggressive breast cancer?
Pre-menopausal breast cancer in her mother.
What information should the practical nurse reinforce while reviewing discharge instructions with a client who has a joint dislocation?
Prescribed exercises should be performed daily.
A male client with increased intracranial pressure (ICP) due to a skull fracture is in the supine position with his legs elevated. What should the practical nurse (PN) do first?
Raise the head 30 degrees and lower the feet.
During the daily assessment of a client with emphysema, the practical nurse (PN) identifies that the client's chest is barrel-shaped and he is demonstrating pursed-lip breathing. Which additional finding requires follow up by the PN?
Rales auscultated bilaterally.
A client who is 3 days postoperative after a laminectomy is coughing up thick green sputum and wheezing. What action is most important for the practical nurse (PN) to implement?
Report the change in condition to the healthcare provider.
A client who was hit in the head with a baseball is admitted to the hospital for observation. Which finding requires the practical nurse (PN) to follow-up with further assessment?
Reports the hospital room is an office.
What is the priority data that the practical nurse (PN) should obtain for a client with a cervical spinal cord injury (SCI)?
Respiratory pattern and airway.
A client who received several units of blood for a hemorrhagic event is reporting muscle cramps and a tingling sensation. Which action should the practical nurse implement?
Review laboratory results for serum calcium and magnesium levels.
Which finding is most important for the practical nurse (PN) to explore further for a client who had a total abdominal hysterectomy and bilateral oophorectomy yesterday?
Right calf is 24 cm and left calf is 21 cm.
A client with heart failure (HF) takes a daily tablet of furosemide (Lasix) and lisinopril (Zestril). Which finding during the clinic visit should indicate to the practical nurse that the client's condition is worsening?
Sleeps with two additional pillows.
A male client with metastatic gastric cancer is being discharged home, but the client and family members are fearful of managing the client's symptoms at home. What action should the practical nurse provide?
Suggest a referral for the client to have hospice care provided in their home.
An older client who has had a cataract in the right eye for several years tells the practical nurse (PN), "Now I have lost the sight in my right eye because I waited too long for treatment." What information should the PN provide?
Surgery can restore vision with corrective lens implants or glasses.
Which finding prompts the practical nurse (PN) to check the nasogastric tube (NGT) placement?
The client has vomited.
A male client who has been taking a four-drug regimen for tuberculosis (TB) tells the practical nurse (PN) that he has finished the first drug, isoniazid, and will start taking rifampin next. How should the PN respond?
The four-drug protocol should be taken concurrently.
The practical nurse (PN) is evaluating the self-care of a client who is recovering at home after a laryngectomy. Which finding indicates to the PN that the client needs additional information?
The salt water solution is dated 3 days ago
What equipment should the practical nurse (PN) ensure is the room for a client after a thyroidectomy?
Tracheostomy tray.
After a stroke, a male client with left hemiplegia ignores his left leg and arm. He is unable to use his right arm to assist with moving his left arm or leg. Which descriptor should the practical nurse (PN) document to describe this behavior?
Unilateral neglect.
A client is receiving a unit of packed red blood cells (RBC's). Which finding should the practical nurse (PN) report to the healthcare provider?
Urticaria on the neck and chest.
Before implementing oral feedings for a client who has had a stroke, which action should the practical nurse (PN) implement?
Verify that the client is able to swallow.
A male client who is unconscious after blunt trauma to the head during a baseball game is admitted for observation for possible epidural hematoma. The client is awake and oriented at each hourly check and becomes more difficult to arouse. Which additional finding should the practical nurse report?
Vomiting
The practical nurse (PN) is reviewing preoperative instructions with a male client who is having surgery today. What question should the PN ask the client to best evaluate his understanding of the surgery?
What do you know about the surgery you are having?
A male client is having an intraocular pressure (IOP) measurement using a tonometer for the first time. The client is fearful that the test hurts and may damage his vision. Which explanation should the practical nurse provide?
A topical anesthetic will be used on the eye surface.
Which instructions should the practical nurse (PN) reinforce with a client who is preparing for discharge after placement of a permanent pacemaker implant? (Select all that apply.)
A. Request the use of special hand scanning at airports.C. Do not lean against the car while the engine is running.D. Keep the regularly scheduled follow-up appointments.
A client who experienced a thrombolic stroke has received recombinant tissue plasminogen activator (TPA)( Alteplase)two hours ago in the emergency center. Which priority precaution should the practical nurse implement for this client on admission to the medical unit?
Bleeding precaution
The wife of a client with a large brain tumor asks the practical nurse (PN) to explain why the tumor should be surgically removed. What is the best response for the PN to provide?
Brain tumors increase cerebral mass, resulting in increased intracranial pressure.
The practical nurse (PN) is performing a focused assessment for a postoperative client who returns to the unit after receiving general anesthesia. Which finding should the PN identify as an indicator that the client is free of respiratory complication?
Breath sounds are clear bilaterally
An older client with presbyopia receives a prescription for corrective lenses. Which information should the practical nurse provide that explains the expected results of the corrective lenses?
Corrects vision for reading and close work.
The practical nurse (PN) is reviewing the plan of care for a client scheduled for a surgical amputation of the left lower leg. Which nursing diagnosis should the PN use as the highest priority for this client after the surgery?
Disturbed body image.
A client with type 2 diabetes mellitus (DM) presents in the clinic with a leg laceration that has not healed in two weeks. Which client data is most important for the practical nurse to collect?
Fingerstick glucose level
A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the practical nurse to report to the healthcare provider?
Hard, rigid abdomen.
The practical nurse (PN) is assisting the occupational health nurse with employee health screening. Which technique should the PN use to determine a client's visual acuity?
Have the client read the Snellen eye chart.
A client's prescription for warfarin (Coumadin) therapy was discontinued three weeks ago and returns to the clinic for follow-up laboratory tests. Which results should indicate to the practical nurse that the medication has been eliminated from the body?
International normalized ratio (INR) of 0.9
A client who is 2-days postoperative for abdominal surgery has a nasogastric tube (NGT) to low continuous suction. The client tells the practical nurse (PN) his mouth is so dry that he has been drinking water to quench his thirst. Which potential imbalance should the PN monitor for development in the client?
Metabolic alkalosis
A male client who is 6 hours post radical nephrectomy has a urine output of 20 ml/hour and his blood pressure has changed from 134/90 to 100/56 in the past hour. Which action should the PN implement?
Notify the healthcare provider of the changes
The practical nurse (PN) should place a client in which position for a thoracentesis?
Sitting upright in a tripod position leaning on an overbed table.
What is the immediate assessment the practical nurse (PN) should implement for a client who returns to the unit after a cardiac catheterization?
Check the client's groin.
The practical nurse (PN) receives a report on a group of clients assigned for the day. Which priority assessment should the PN implement?
Check the pulse oximeter for a client with myasthenia gravis.
A male client with peptic ulcer disease complains of feeling weak and dizzy. The practical nurse (PN) observes that the client is diaphoretic, has a firm abdomen, thready pulse at 104 beats/minute, and blood pressure of 90/50. Which action should the PN implement?
Notify the healthcare provider
A male client who had a stroke is incontinent of urine. Which action should the practical nurse (PN) implement in providing bladder training?
Offer the client the commode or urinal every two hours.
The practical nurse (PN) is reviewing discharge instructions with a client after out-patient surgery. Which client response indicates to the PN the need for teaching reinforcement?
Pain medication should be taken every day.
An adult client with otitis media has thick, yellow drainage from the right ear canal. What additional findings should the practical nurse (PN) expect to identify?
Pain relief after ear drainage begins.
The practical nurse (PN) is caring for a client with chronic obstructive pulmonary disease (COPD). To reduce carbon dioxide ( CO 2 ) retention in the lungs, which information should the PN reinforce?
Use pursed-lip and abdominal breathing.
The practical nurse (PN) is caring for a client who is receiving radiotherapy for cancer of the larynx. Which information should the PN provide the client to reduce the undesirable effects of radiation?
Use sugarless gum and candy to increase salivary secretions.
The practical nurse (PN) is implementing a focused assessment of a client's musculoskeletal system. Which family history finding should the PN identify as an increased risk factor for the client?
Osteoporisis.
While completing preoperative preparation for a client admitted for same-day surgery, what evaluation statement should the practical nurse identify as an important outcome?
Asks questions regarding the surgical experience
The practical nurse (PN) determines that a client's nasogastric tube (NGT), which is attached to low intermittent suction, has a decreased amount of drainage in the collection unit. Gastric secretions have pooled in the tubing and do not move with the onset of intermittent suction. Which action should the PN implement?
Assess the placement of the NGT.
An older male with a history of emphysema arrives to the emergent care center with complaints of increasing dyspnea on exertion. The client's chest has an increased anteroposterior diameter, a dry, hacking cough, and pulse oximetry of 89%. What action should the practical nurse take?
Apply oxygen per nasal cannula at 2 L/minute.
A male client with diabetes mellitus calls the clinic to report left calf pain after walking around the block. Which additional information should the PN report to the healthcare provider?
The pain is immediately relieved when he sits down.
The practical nurse (PN) is completing focused assessments for four clients. Which client finding should be the PN's first priority?
A client with asthma who is coughing and has distant auscultated breath sound
