LVN LEVEL III PREP U QUESTIONS

A client with generalized anxiety disorder (GAD) is prescribed a benzodiazepine, but the client doesn't want to take the medication. Which explanation for this behavior would most likely be correct?

"I want to solve my problems on my own." Explanation: Many clients don't want to take medications because they believe that using a medication is a sign of personal weakness and that they can't solve their problems by themselves. Thinking that the psychiatrist dislikes them reflects paranoid thinking that isn't usually seen in clients with GAD. By waiting several weeks to take the medication, the client could be denying that the medication is necessary or beneficial. By focusing on the negative motives of family members, the client could be avoiding talking about himself.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day." Explanation: Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but then should disappear.

A client approaches the nurse and points at the sky, showing her where the men would be coming from to get him. Which response is most therapeutic?

"It seems like the world is pretty scary for you, but you're safe here." Explanation: Explaining that the world is scary but the client is safe acknowledges the client's fears and feelings, and offers a sense of security as the nurse tries to understand the symbolism. She reflects these concerns to the client, along with reassurance of safety. The first response validates the delusion, not the feelings and fears, and doesn't orient the client to reality. The second response gives false reassurance; because the nurse isn't sure of the symbolism, she can't make this promise. The last response rejects the client's feelings and doesn't address his fears.

Five days after running out of medication, a client taking clonazepam (Klonopin) says to the nurse, "I know I shouldn't have just stopped the drug like that, but I'm okay." Which response would be best?

"You could go through withdrawal symptoms for up to 2 weeks." Explanation: Withdrawal symptoms can appear after 1 or 2 weeks because this benzodiazepine has a long half-life. Looking for another problem unrelated to withdrawal isn't the nurse's best strategy. The act of discontinuing an antianxiety medication doesn't indicate that a client has learned to cope with stress. Every client taking medication needs to be monitored for withdrawal symptoms when the medication is stopped abruptly.

A nurse is discussing nutrition with a primigravida. The client states that she knows that calcium is important during pregnancy but that she and her family don't consume many milk or dairy products. What advice should the nurse give?

"You should consume other non-dairy foods that are high in calcium." Explanation: Food is considered the ideal source of nutrients. However, milk and dairy aren't the only food sources of calcium. While prenatal vitamins are generally recommended, they don't satisfy all requirements. The calcium requirement for pregnancy is 1,300 mg/day. Over-the-counter supplements aren't always safe and should be specifically recommended by the health care practitioner. While it's true that all fetal organs are formed by the end of the first trimester, development continues throughout pregnancy.

A client who has just been diagnosed with myocardial infarction (MI) begins to cry and tells the nurse that his brother died of a heart attack last year. Which response by the nurse is most appropriate?

"You sound as though you think you're going to die." Explanation: The client's questions and concerns should be acknowledged and addressed by the nurse after an MI. The nurse shouldn't give false reassurance or ignore the client's immediate concern.

During the admission assessment, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What's the nurse's best response?

"You're having a panic attack. I'll stay here with you." Explanation: During a panic attack, the nurse's best approach is to orient the client to what's happening and provide reassurance that the client won't be left alone. The client's anxiety level is likely to increase—and the panic attack is likely to continue—if the client is told to calm down, asked the reasons for the attack, or is left alone.

During a vaginal examination of a client in labor, the obstetrician determines that the biparietal diameter of the fetal head has reached the level of the ischial spines. The most accurate documentation of this fetal station would be:

0 Explanation: When the largest diameter of the presenting part (typically the biparietal diameter of the fetal head) is level with the ischial spines, the fetus is at station 0. A station of -1 indicates that the fetal head is 1 cm above the ischial spines. At +1, it's 1 cm below the ischial spines. At +2, it's 2 cm below the ischial spines.

During a prenatal visit, the nurse measures a client's fundal height at 19 cm. This measurement indicates that the fetus has reached approximately which gestational age?

19 weeks Explanation: The fundal height measurement in centimeters equals the approximate gestational age in weeks, until week 32. Thus, fundal height at 12 weeks is 12 cm; at 24 weeks, 24 cm; and at 28 weeks, 28 cm.

Which principle of the psychoanalytic model is particularly useful to psychiatric nurses?

All behavior has meaning. Explanation: The principle that all behavior has meaning is of particular importance to the psychiatric nurse. It serves as the basis for the nurse's assessment and analysis of the client's behavior, which reflects the client's needs. Psychoanalytic theory also proposes that the first 6 years of a person's life determine personality; these early influences are difficult, if not impossible, to counteract. However, this assumption is less useful to the nurse in planning interventions that meet the client's current needs. Reinforcement as a means of perpetuating behavior is associated with behavioral theory, not the psychoanalytic model. Incongruence between verbal and nonverbal communications is a part of communications theory.

Which intervention should the nurse implement in the client scheduled for aminocentesis?

Allow the client to void Explanation: Before amniocentesis, the client should void to empty the bladder, reducing the risk of bladder perforation. The client doesn't need to drink fluids before amniocentesis nor does she need to fast. The client should be placed in a supine position for the procedure.

A nurse notices that a client who came to the clinic for treatment of anxiety disorder has a strong body odor. What can the nurse do or say to help this client?

Ask the client basic hygiene questions to determine how frequently he bathes. Explanation: The nurse should inquire about the client's basic hygiene to help determine the cause of his strong body odor. The nurse can then devise a plan of care based on the information she obtains. Offering the client an opportunity to freshen up doesn't address the problem and might offend him. Preparing the client for his examination and then leaving the room doesn't address the hygiene issues. Providing the client with personal care items also might offend him.

A 33-year-old female client tells the nurse she has never had an orgasm. She tells the nurse that her partner is upset that he can't meet her needs. Which nursing intervention is most appropriate?

Assess the couple's perception of the problem Explanation: Assessing the couple's perception of the problem will define it and assist the couple and the nurse in understanding it. A nurse can't make a medical diagnosis such as sexual aversion disorder. Most women can be taught to reach orgasm if there's no underlying medical condition. When assessing the client, the nurse should be professional and matter-of-fact; she shouldn't make the client feel inadequate or defensive

A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?

Assist the client with feeding. Explanation: According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.

A family meeting is held with a client who abuses alcohol. While listening to the family, which unhealthy communication pattern might be identified?

Avoidance of issues that cause conflict Explanation: The interaction pattern of a family with a member who abuses alcohol commonly revolves around denying the problem, avoiding conflict, or rationalizing the addiction. Health care providers are more likely to use jargon. The family might have problems setting limits and expressing disapproval of the client's behavior. Nonverbal communication usually gives the nurse insight into family dynamics

A client is progressing through the first stage of labor. Which finding signals the beginning of the second stage of labor?

Bearing-down reflex Explanation: The second stage of labor is heralded by a bearing-down reflex with each contraction, increased bloody show, severe rectal pressure, and rupture of the membranes (if this hasn't already occurred). Passage of the mucus plug typically occurs during the latent phase of the first stage of labor. A change in uterine shape and a gush of dark blood occur during the placental separation phase of the third stage of labor.

A client had transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. What should the nurse do first for this client?

Check for the presence of clots, and make sure the catheter is draining properly Explanation: Blood clots and blocked outflow of the urine can increase spasms. The irrigation shouldn't be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.

When assessing a client with glaucoma, the nurse expects which finding?

Complaints of halos around lights Explanation: Glaucoma is largely asymptomatic. Symptoms that occur can include loss of peripheral vision or blind spots, reddened sclera, firm globe, decreased accommodation, halos around lights, and occasional eye pain. Normal intraocular pressure is 10 to 21 mm Hg.

A client tells a nurse that her ileoconduit appliance won't adhere to her skin. The nurse inspects the site and notes that the area around the stoma is red, moist, and tender to touch. How should the nurse intervene?

Consult the wound-ostomy nurse. Explanation: The skin is most likely excoriated from urine leaking from the appliance. The nurse should consult the wound-ostomy nurse, who can suggest care interventions. Some facilities require a physician's order to obtain a wound culture. Patting the skin dry and applying a new appliance won't address the problem with the appliance. Applying skin adhesive spray to excoriated skin will further irritate the skin and increase the client's discomfort.

The nurse is collecting data on a geriatric client with senile dementia. Which neurotransmitter condition is likely to contribute to this client's cognitive changes?`

Decreased acetylcholine level Explanation: A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy geriatric clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep- wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

A nurse places a client in full leather restraints. How often must the nurse check the client's circulation?

Every 15 minutes Explanation: Circulatory as well as skin and nerve damage can occur quickly. Therefore, circulation should be assessed at least every 15 minutes. Checking every hour, 2 hours, or 8 hours isn't often enough and could result in permanent damage to the client's extremities.

Because uteroplacental circulation is compromised in clients with preeclampsia, a nonstress test (NST) is performed to detect which condition?

Fetal well-being Explanation: An NST is based on the theory that a healthy fetus has transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually won't have these accelerations, which indicate a nonreactive NST. An NST can't detect anemia in a fetus. Serial ultrasounds will detect IUGR and oligohydramnios in a fetus.

A client is diagnosed with pericarditis. The nurse anticipates that the client may exhibit which signs and symptoms?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. All other symptoms may result from acute renal failure.

Which drug will the physician most likely prescribe for the client admitted with a lorazepam (Ativan) overdose?

Flumazenil (Romazicon) Explanation: Flumazenil reverses the sedative effects of benzodiazepines such as lorazepam. The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites. Deferoxamine mesylate is the antidote for iron intoxication. Succimer is an antidote for lead poisoning.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to monitor for which adverse reaction?

Granulocytopenia Correct Explanation: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.

A nurse is trying to determine if a client who abuses heroin has any drug-related legal problems. Which assessment question is the best to ask the client?

Have you received any legal violations related to your drug use? Explanation: Asking about legal violations related to drug use provides direct information about drug-related legal problems. When a spouse becomes aware of a partner's substance abuse, the first action isn't necessarily to institute legal action. Even if the client reports to a probation officer, the offense isn't necessarily a drug-related problem. Asking if the client has a history of frequent visits with the employee assistance program manager isn't useful; it assumes any such visit is related to drug issues.

A client in labor receives epidural anesthesia. The nurse should assess carefully for which adverse reaction to the anesthetic agent?

Hypotensive crisis Explanation: Hypotensive crisis may occur after epidural anesthesia administration as the anesthetic agent spreads through the spinal canal and blocks sympathetic innervation. Other signs and symptoms of hypotensive crisis associated with epidural anesthesia may include fetal bradycardia (not tachycardia) and decreased (not increased) beat-to-beat variability in the FHR. Urine retention, not renal toxicity, may occur during the postpartum period.

When obtaining the vital signs of a client with multiple traumatic injuries, the nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?

Increased intracranial pressure (ICP) Explanation: Decreased heart and respiratory rates and increased systolic blood pressure reflect Cushing's triad, which may develop when ICP increases. Shock typically causes tachycardia, tachypnea, and hypotension. In encephalitis, the temperature rises and the heart and respiratory rates may increase from the effects of fever on the metabolic rate. If the client doesn't maintain adequate hydration, hypotension may occur. Status epilepticus causes unceasing seizures, not changes in vital signs.

The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important?

Increasing fluid intake to 3 L/day Explanation: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. This helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

Which symptom, when observed in laboring clients with gestational hypertension, would most likely indicate a worsening condition?

Increasing oliguria Explanation: Renal plasma flow and glomerular filtration are decreased in gestational hypertension, so increasing oliguria indicates a worsening condition. Blood pressure increases as a result of increased peripheral resistance. Increasing (not decreasing) edema would suggest a worsening condition. Trace levels to +1 proteinuria are acceptable; higher levels would indicate a worsening condition.

Which medication is considered safe during pregnancy?

Insulin Explanation: Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.

An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

Lack of self-esteem, strong dependency needs, and impulsive behavior Explanation: Borderline personality disorder is characterized by lack of self-esteem, strong dependency needs, and impulsive behavior. Instability in interpersonal relationships, mood, and poor self-image also are common. The client typically can't tolerate being alone and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and unusual dress are characteristic of schizoid personality disorder. Suspiciousness, hypervigilance, and emotional coldness are seen in paranoid personality disorders. In antisocial personality disorder, clients are usually insensitive to others and act out sexually; they may also be violent.

After an anterior wall myocardial infarction (MI), which problem is indicated by auscultation of crackles in the lungs?

Left-sided heart failure Explanation: The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

Which characteristics would the nurse expect to see in the client with schizophrenia?

Loose associations, grandiose delusions, and auditory hallucinations Explanation: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar disorder. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.

The nurse is caring for a client who has bulimia. What is a common metabolic complication associated with bulimia?

Metabolic alkalosis Explanation: With repeated emesis, the client with bulimia loses stomach acids, thus becoming alkalotic. Respiratory pH disturbances aren't directly related to bulimia.

A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, tachycardia, altered consciousness, and diaphoresis. These findings suggest which life-threatening reaction?

Neuroleptic malignant syndrome Explanation: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports stopping smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, the nurse should recommend which additional measure?

Taking daily walks Explanation: Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Aerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not avoid, foods that raise HDL levels

A nurse is caring for a patient experiencing a panic attack. Which intervention by the nurse would be most appropriate?

Tell the client to take deep breaths Explanation: During a panic attack a client may experience symptoms of dizziness, shortness of breath, and feelings of suffocation. The nurse should remain with the client and direct what's said toward changing the physiological response, such as taking deep breaths. During an attack, the client is unable to talk about anxious situations and isn't able to address feelings, especially uncomfortable feelings and frustrations. While having a panic attack, the client is also unable to focus on anything other than the symptoms, so the client won't be able to discuss the cause of the attack

A client, 2 months pregnant, has hyperemesis gravidarum. Which expected outcome is most appropriate for her?

The client will exhibit uterine growth within the expected norms for gestational age. Explanation: For a client with hyperemesis gravidarum, the goal of nursing care is to achieve optimal fetal growth, which can be evaluated by monitoring uterine growth through fundal height assessment. The nurse shouldn't assume that excessive vomiting signifies that the client doesn't accept the pregnancy. Clients with hyperemesis gravidarum rarely gain weight according to the expected pattern. They may be hospitalized briefly to regulate fluid and electrolyte status, but they don't require hospitalization for the duration of pregnancy. In fact, hospitalization may add to the stress of pregnancy by causing family separation and financial concerns.

Which outcome is most appropriate for a teenager who's irritable, hasn't slept well in 6 months, and has dropped out of social activities?

The client will obtain appropriate mental health services Explanation: Mental health services can protect the client and offer the best means of regaining mental health. The client could reestablish a healthy sleeping pattern without addressing underlying issues. The parents' worrying is unrelated to the child's immediate need for help. The child's behavior suggests the need for professional service, not disciplinary measures.

A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup. After the nurse explains the diagnostic tests, the client asks which part of the kidney "does the work." Which answer is correct?

The nephron Explanation: The nephron, the functioning unit of the kidney, includes the glomerulus, Bowman's capsule, and tubular system, which work together to form urine.

Which statement is correct about conversion disorders?

The psychological conflict is repressed Explanation: In conversion disorders, the client isn't conscious of intentionally producing symptoms that can't be self-controlled. The symptoms are characterized by one or more neurologic symptoms. Understanding the principles and conflicts behind the symptoms can prove helpful during a client's therapy.

A client with dissociative identity disorder (DID) is admitted to an inpatient psychiatric unit. A nurse-manager asks all staff to attend a meeting. Which is the most likely reason for the meeting?

To allow staff members to discuss concerns about working with a client with DID Explanation: Allowing all staff members to meet together may prevent them from splitting into groups who believe the diagnosis is valid and those who don't. Unless this client shows behaviors harmful to himself or others, restraints aren't needed. Telling the staff that no one should refuse to work with the client or that this client will probably be difficult sets a negative tone as the staff develops a plan of care for the client and implements it.

A client who's diagnosed with a right subarachnoid hemorrhage should be placed in which position?

With the head of the bed elevated Explanation: Elevating the head of the bed enhances cerebral venous return and thereby decreases intracranial pressure (ICP). The other positions wouldn't decrease ICP.

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril), 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

a calming effect from which the client is easily aroused. Explanation: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

The nurse assesses a client for evidence of postpartum hemorrhage during the third stage of labor. Early signs of this postpartum complication include:

an increased pulse rate, increased respiratory rate, and decreased blood pressure. Explanation: An increased pulse rate followed by an increased respiratory rate and decreased blood pressure may be the first signs of postpartum hemorrhage and hypovolemic shock.

A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:

an unknown cause. Explanation: The cause of hyperemesis gravidarum isn't known. However, etiologic theories implicate hormonal alterations and allergic or psychosomatic conditions. No evidence suggests that hyperemesis gravidarum results from a neurologic disorder, inadequate nutrition, or hemolysis of fetal RBCs.

The nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client:

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. Explanation: Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects data collection to reveal:

unpredictable behavior and intense interpersonal relationships. Explanation: A client with borderline personality disorder displays a pervasive pattern of unpredictable behavior, mood, and self-image. Interpersonal relationships may be intense and unstable, and behavior may be inappropriate and impulsive. Although the client's impaired ability to form relationships may affect parenting skills, inability to function as a responsible parent is more typical of antisocial personality disorder. Somatic symptoms characterize avoidant personality disorder. Coldness, detachment, and lack of tender feelings typify schizoid and schizotypal personality disorders.

During data collection, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:

waxy flexibility. Explanation: Waxy flexibility is defined as retaining any position that the body has been placed in. Somatic delusions involve a false belief about the functioning of the body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self, others, or the world.