HESI EXIT EXAM VERSION 1 QUESTIONS AND ANSWERS WITH RATIONALES GRADED A 2025

The practical nurse (PN) performs a random blood glucose test for a client with a history of hypoglycemia and complains of dizziness. After test completion, which action should the PN perform first? Remove gloves and wash hands. Document results and actions in the medical record. [AUTHOR] 1 lOMoAR cPSD| Dispose of lancet and test strip in proper receptacle. Discuss the test results with the client. Rationale Disposal of the lancet and test strip (C) prevents the transmission of bloodborne pathogens and is the priority. (A, B, and D) should follow, implementing sharps precautions. Regarding client confidentiality, what information represents the correct understanding by the practical nurse of the guidelines set forth by HIPAA (Health Insurance Portability and Accountability Act)? Only clients can pick up their prescriptions at a pharmacy. Past medical records for clients should be stored in a secured place. Computers that access client information cannot be in the public part of a nursing station. Whiteboards with a list of client names are prohibited in areas that the public can see. Rationale The Health Insurance Portability and Accountability act of 1996 (HIPPA) establishes that records with protected health information (PHI) must be stored in a secured place. The other options are not part of the HIPPA act. Which action should the practical nurse (PN) implement to provide a sense of control to a toddler who is hospitalized? Put a cover over the child's crib. lOMoAR cPSD| Ask parents to stay with the child. Assign the same nurses to care for the child. Follow the child's usual routines for feeding and bedtime. Rationale Routines are important to toddlers and give the child a sense of control, so following the child's usual routines during hospitalization should be implemented as much as possible. Which interventions should the practical nurse (PN) implement in the postoperative period for a client who had surgery for cancer of the oral cavity? (Select all that apply.) Select all that apply Provide meticulous oral hygiene. Advise the client to avoid straining at stool. Obtain daily weights to determine need for NGT feedings. Observe for temporary or permanent loss of taste. Monitor for gastric indigestion. Rationale Postoperative problems related to excision of a cancerous lesion in the oval cavity include the risk for infection, delayed wound healing in the oral mucosa, and gustatory deficits, if the client's tongue is resected or biopsied. Meticulous oral hygiene reduces oral flora and minimizes the risk for infection. Monitoring daily weight provides information about the client's need for supplemental NGT feedings to improve nutritional intake for healing and recovery. Observing for temporary or permanent loss of taste may indicate trauma of the tongue and glossopharyngeal nerve. lOMoAR cPSD| Which intervention is most important for the practical nurse to implement when suctioning the nasopharyngeal airways for a child after cardiac surgery? Perform oropharyngeal suctioning PRN. Suction for no longer than 5 seconds at a time. Assess for symptoms of respiratory distress during suctioning. Administer supplemental oxygen before and after suctioning. Rationale Hypoxia increases the cardiac workload after cardiac surgery, so supplemental oxygen should be administered with a manual resuscitation bag before and after suctioning (D) to prevent hypoxia. Although (A, B, and C) should be implemented, providing oxygenation is most important. To maintain a patent airway, oropharyngeal suctioning for a child after cardiac surgery should be performed PRN without deep insertion of the suction catheter which can cause vagal stimulation and laryngospasm. Suctioning should be intermittent and maintained for no more than five seconds to prevent depleting the oxygen supply. Signs of respiratory distress warrant cessation of suctioning if the client is experiencing intolerance. A female client with terminal cancer is tearful and is becoming increasingly withdrawn from her family and the nursing staff. She refuses medications, treatments, food, and frequently says, "Why is God doing this to me?" Which intervention should the practical nurse implement? Monitor for an increased suicide risk. Implement measures to reduce her pain level. Contact her religious advisor to help her face death. lOMoAR cPSD| Initiate discussions about her wishes for end-of-life care. Rationale The client's religious advisor should be contacted to assist the client cope with her spiritual distress regarding death (C). Although discussions about end-of-life care (D) should be initiated, the client's religious advisor, family, or healthcare provider should assist her in coordinating her wishes. The client's physical distress is influenced by (A and B) but do not address her expressed spiritual needs. Which pathophysiological findings are characteristic in children with cystic fibrosis (CF)? (Select all that apply.) Select all that apply Diabetes mellitus. Excessive salivation. Abnormal bone ossification. Pancreatic enzyme deficiency. Hypochloremia and hyponatremia. Viscous respiratory secretions. Rationale Correct selections are (D, E, and F). CF is characterized by exocrine gland dysfunction that produces thick, tenacious respiratory secretions (F), pancreatic enzyme deficiencies (D), and abnormally elevated chloride and sodium concentrations in the sweat (E). Diabetes is common with cystic fibrosis but is not a pathophysiological finding of CF (A). Impaired salivation, not (B), occurs from patchy fibrosis of salivary glands. Although impaired absorption of vitamin D and calcium utilization can lead to impaired bone formation (C), it is not considered a hallmark of CF. lOMoAR cPSD| Which factor should the practical nurse (PN) consider prior to providing morning hygiene care to a male client who is of Middle-Eastern descent ? Skin color. Economic status. Personal preferences. Sociocultural background. Rationale Hygiene is considered an invasion of personal space, and clients vary in their perceptions of how and who may assist in their care. Personal preferences (C) should be assessed in advance of hygiene care. Skin color (A), economic status (B), and sociocultural background (D) do not address the client's perceptions or preferences. The caregiver of an 88-year-old client tells the practical nurse (PN) that the client takes frequent naps during the day and awakens frequently during the night. Which information should the PN provide? The client should be given a hypnotic to ensure an adequate sleep pattern through the night. To prevent fatigue, an older client should obtain at least 10 hours of sleep in 24 hours. An older client should nap less during the day to ensure a longer sleep pattern at night. It is normal for an aging client to awaken more often during the night and nap during the day. lOMoAR cPSD| Rationale Sleep habits are individualized, but an older client normally sleeps less at night with more naps taken during the day, so the caregiver should be reassured that this is an expected, normal sleep pattern (D) for the client. (A) places the client at risk for dependency and is not indicated. (B and C) are inaccurate. The practical nurse (PN) is caring for an older client with an infection. Which finding should the PN anticipate as a delayed response in this client? Fever. Fatigue. Malaise. Confusion. Rationale An early systemic immune response is fever, but older clients are at risk for an impaired immune response related to chronic illness or polypharmacy, such as anti-inflammatory steroids. This older client may manifest fever after presenting with fatigue, malaise, and confusion. Which client receiving infusion therapy is the best assignment for the practical nurse (PN)? Client who hemorrhaged and needs a unit of whole blood started on admission to the postoperative unit. Client who is receiving diltiazem (Cardizem) IV titrated for a heart rate between 60 to 80. lOMoAR cPSD| Client who requires fingerstick glucose checks while receiving a regular insulin IV solution. Older adult client who is confused and has a peripheral saline lock that should to be flushed every eight hours. Rationale Client acuity is affected by unstable health alterations that require multisystem organ assessment and determines client care assignments that should be aligned with the PN or RN scope of practice. An older adult client with a saline lock that is routinely flushed for patency every 8h is a non-complex care assignment within the scope of practice for the PN. An older client is being discharged from the hospital to return to the assisted living community after undergoing a right hip replacement. The client is using a four-point walker. When planning the client's discharge, which member of the healthcare team is most important for the practical nurse to coordinate continued care for the client? Case manager. Physical therapist. Occupational therapist. Social worker. Rationale To establish the client's independence, the physical therapist (B) should continue the client's progression of mobility in the assisted living facilty. (A, C, and D) are all available ancillary health care members that can be utilized if needed for other client needs, but (B) is the priority for the client to regain independent mobility. lOMoAR cPSD| A new father asks the practical nurse (PN) the reason for placing an ophthalmic ointment in his newborn's eyes. What information should the PN provide? Possible exposure to an environmental staphylococcus infection can infect the newborn's eyes and cause visual deficits. The newborn is at risk for blindness from a corneal syphilitic infection acquired from a mother's infected vagina. Treatment prevents tear duct obstruction with harmful exudate from a vaginal birth that can lead to dry eyes in the newborn. State law mandates all newborns receive prophylactic treatment to prevent gonorrheal or chlamydial ophthalmic infection. Rationale Many states mandate prophylactic use of erythromycin ointment in all newborn's eyes within 2 hours of birth because of the risk of blindness from an ophthalmic infection acquired during a vaginal birth, if the mother is infected with a gonorrheal or chlamydial organism (D). (A, B, and C) are inaccurate. A client who has been taking furosemide (Lasix) for the past two months is 2 days postoperative for a suprapubic prostatectomy. After breakfast, the client is in the bathroom straining to have a bowel movement when he calls the practical nurse (PN) complaining of sudden onset of shortness of breath and acute chest pain. Which condition should the practical nurse (PN) assess the client? Stable angina pectoris. Pulmonary edema. lOMoAR cPSD| Pulmonary embolism. Gastroesophageal reflux. Rationale The client's postoperative status and possible dehydration related to recent use of Lasix places the client at risk for pulmonary embolism, which is a postoperative complication characterized by acute chest pain and shortness of breath precipitated by straining on stool. (A, B, and D) are not characterized by chest pain and shortness of breath associated with a Valsalva maneuver. Which finding should the practical nurse (PN) report to the healthcare provider that indicates a client with cirrhosis is progressing to hepatic encephalopathy (hepatic coma)? 2+ pitting edema up to the lower thighs. Serum clotting results three times above normal. Spider nevi (telangiectasias). Serum ammonia levels twice the normal value. Rationale Hepatic coma results in cerebral dysfunction when serum ammonia is not eliminated and builds up in the bloodstream (D). (A, B, and C) are all expected findings for clients with cirrhosis, but elevated serum ammonia level is indicative of hepatic failure. Which finding in a newborn is most important for the practical nurse (PN) to report? Clinical jaundice evident on the forehead within 24 hours of birth. Icterus color of blanched skin on the thorax at day 3 after birth. lOMoAR cPSD| Serum bilirubin concentrations less than 2 mg/dl in cord blood. Bilirubin level of 4 mg/dl using a transcutaneous bilirubinometry. Rationale Jaundice is clinically visible when bilirubin levels reach 5 to 7 mg/dl and appears in a cephalocaudal manner, first noticed in the head and then progresses gradually to the thorax, abdomen, and extremities. Clinical jaundice that is evident within 24 hours of birth (A) warrants immediate attention and is pathological. Although additional assessments of physiological jaundice (B) should be made, jaundice in the first 24 hours is life threatening and requires immediate intervention. Neonatal serum bilirubin levels (C) (range is 1 to 12 mg/dl in the first week of life) and transcutaneous bilirubin meters (D) provide accurate measurements for planning care, but jaundice in the first 24 hours, despite serum bilirubin levels, is the priority. The practical nurse (PN) is reviewing the medical record for an infant with hydrocephalus. Which focused assessment finding should the PN document? Constricted pupils. A sunken anterior fontanel. Increased head circumference. Decreased luminosity of the head. Rationale A classic sign of hydrocephalus is an increase in head circumference (C) due to the increase in cerebrospinal fluid (CSF), which should be identified during a focused assessment and documented in the medical record. The pupils are not constricted (A) with hydrocephalus. A sunken anterior fontanel (B) occurs with dehydration. Due to the increase in CSF, there is an increase in luminosity of the cranium, not (D). lOMoAR cPSD| Which incident should the practical nurse identify as a client confidentiality violation under the Health Insurance Portability Accountability Act (HIPAA) regulations? A nurse conveys client status information to an inquiring friend on the phone without the client's permission. The unit secretary faxes a client's old records from the office to the emergency center without a written consent. A client overhears a verbal prescription in the next room during a cardiac arrest of another client. A client discusses his personal history of kidney stones with another client in the unit's lounge area. Rationale HIPAA requires that client permission should be obtained before releasing any client information to unknown parties or non-caretaking individuals. The other options are not HIPPA violation. The practical nurse (PN) is planning care for a client who is admitted with a Braden scale score of 2 in each of the six subcategories. Toward which goal in the client's care should the PN focus nursing interventions? Prevention of pressure ulcers. Improved hygienic measures. Temperature within normal limits. Absence of signs of infection. lOMoAR cPSD| Rationale The Braden scale measures degrees of sensory perception, moisture, activity, mobility, nutrition, friction, and shear that indicate a client's risk for skin breakdown. A score of 12 indicates the client's plan of care should include a goal that focuses on the prevention of skin breakdown (A). Improved hygiene (B), normal temperature (D), and absence of infection (C) are related to altered skin integrity, but this assessment tool allows the nurse to plan interventions to prevent skin breakdown. The practical nurse (PN) is caring for a child who is receiving chemotherapy for leukemia. The child's granulocyte count is 250/ mm 3 and the platelet count is 20,000/ mm 3 . Which intervention should the PN implement when performing oral hygiene? Use a toothbrush and floss once a day. Rinse the mouth out with lukewarm water. Clean the teeth with a toothbrush twice daily. Wipe teeth with moistened gauze sponges. Rationale Based on the child's laboratory results, the child is at risk for bleeding and infection. To minimize trauma and the risk of bleeding, the PN should cleanse the teeth with moistened gauze sponges (D). (A and C) create friction and can cause the gums to bleed. (B) provides minimal removal of plaque build-up. An older Hispanic male is admitted with a nutritional deficiency and is prescribed a regular diet. The client frequently says that lOMoAR cPSD| he dislikes the hospital foods and wants to eat food brought in by his family. Which response is best for the practical nurse (PN) to provide? Thank the family for bringing the foods that the client likes to eat. Request that the dietitian review the nutritional content of family foods. Warn the family about the need for adequate food temperature control. Explain to the family that the hospital is providing a balanced diet. Rationale Culture affects acceptability of food, as well as patterns of food intake. Since nutritional requirements depend on many factors, adequacy of the diet brought by the family should be determined (B). Although (A, C, and D) may be implemented, the client's preferences should be considered to ensure the client eats a diet that meets his nutritional needs. Which anticholinergic agent is used for brady dysrhythmias? Atropine. Hyoscyamine (Levsin). Dicyclomine (Bentyl). Glycopyrrolate (Robinul). Rationale Atropine (A) is an anticholinergic drug that increases the heart rate and is used in bradydysrhythmias. (B) is used to manage gastric secretion and spastic bladder spasm. (C) is used to treat disturbances of GI motility, such as irritable bowel syndrome. (D) is used as an antisecretory. lOMoAR cPSD| Which question should the PN ask an older male client to best determine the nature of his pain? "How bad is it?" "Can you describe the pain for me?" "Did the pain medication give you relief?" "Is this pain the same as you had before?" Rationale Having the client describe the pain in his own words (B) determines the nature and severity of the present sensations. (A) is a close-ended question and does not help the client focus on the specific character of the pain. (C) is an evaluation of therapy. (D) does not describe the current experience of pain. A young child is brought to the emergent care center whose mother is screaming hysterically and states that her child has been beaten. The practical nurse (PN) finds the unlicensed assistive personnel (UAP) crying in the hallway about the child's condition. What action should the PN take? Remind the UAP to control her feelings while at work. Call for the chaplain to come and speak to the UAP. Support the UAP by going to a private area to talk. Walk past the UAP in order to allow for privacy. Rationale The PN should offer emotional support by going with the UAP to a private area to talk about the situation (C). (A and D) ignore the emotional impact the client's case has made lOMoAR cPSD| on the staff member. (B) may be indicated if the staff member requests additional support. An infant is admitted to the hospital with dehydration and diarrhea. What is the best liquid that the practical nurse (PN) should provide? Pedialyte. Water. Apple juice. Ginger ale. Rationale Infants with acute diarrhea and dehydration should be offered oral rehydration solutions (ORS) that do not contribute to diarrhea. Pedialyte (A) is a commercially prepared over-the- counter ORS that provides the infant with fluids and electrolytes. Fluids with a high glucose or sodium content, such as fruit juice (C), colas, and soft drinks (D), should not be used. After an infant is rehydrated with an ORS, maintenance fluid therapy can progress with alternating an ORS with a low-sodium fluid, such as water (B), and simple protein and starch feedings, such as rice, potato, yogurt, fruits, vegetables, cereal, or bread, which can lessen fluid loss. The practical nurse (PN) is caring for a school-aged child with Reye's syndrome. What action is most important for the PN to implement? Observe the skin for petechiae. Reposition every 2 hours. Monitor intake and output. lOMoAR cPSD| Perform range-of-motion exercises. Rationale Reye's syndrome is characterized by a nonspecific encephalopathy with fatty degeneration of the liver and is triggered by a virus, particularly influenza or varicella, in association with the concurrent use of salicylates. Fluid management focused on monitoring and treating increased intracranial pressure (ICP) is crucial, so monitoring intake and output (C) is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Although (A, B, and D) should be implemented, (C) is essential in preventing life- threatening complications related to ICP. The practical nurse (PN) is caring for a 2-year-old child with Wilms' tumor. Which intervention is most important for the PN to implement? Check skin turgor for elasticity and hydration. Place a sign in the room stating no abdominal palpation. Auscultate all lung fields for abnormal breath sounds. Distract the child with a toy during daily assessments. Rationale Abdominal palpation in a child with Wilms' tumor can cause the cancer to spread throughout the peritoneum, so it should be prohibited by placing a sign in the child's room. Based on these clients' laboratory results, which client should be assigned to the practical nurse (PN)? Client with a serum sodium of 129 mEq/L. Client with a serum calcium of 9.5 mg/dl. lOMoAR cPSD| Client with a serum potassium of 6.0 mEq/L. Client with a serum phosphorus of 2.7 mEq/L. Rationale Non-complex client acuity determines client care assignments that should be aligned with the PN's scope of practice. Client who has a serum calcium (9.5 mg/dl) within normal limits is least likely to experience complications and is the best assignment for the PN. A terminally ill male client and his family are requesting hospice care after discharge and ask the practical nurse (PN) to explain what kind of care they should expect. The PN should indicate that hospice philosophy focuses on what aspect of health care? Offers ways to postpone the death experience at home. Facilitates assisted suicide with the client's consent. Provides training for family members to care for the client. Enhances symptom management to improve end-of-life quality. Rationale Symptom management (D), such as pain control and comfort measures, is part of the philosophy of hospice care. Hospice philosophy does not include ways to postpone death (A), support for assisted suicide (B), or ensure family members are capable caregivers (C). Which action should the practical nurse (PN) implement when giving medications to a 3-year-old child? Instruct the child of the urgency to take the medication right away. Offer the child the option to take the medication orally or by injection. lOMoAR cPSD| Compare the child's actions to another child who readily takes medication. Allow the child to choose fruit punch or apple juice with oral medications. Rationale Giving the child the chance to make a choice between fruit punch or apple juice allows the child to exert control when medications are required during hospitalization and therefore obtain the child's cooperation. Based on The Joint Commission (TJC) standards for pain assessment and treatment, which action is most important for the practical nurse (PN) to implement when assessing a client? Use a pain scale to assess all clients for pain when obtaining vital signs. Collect objective information about pain to provide the best prescribed treatment. Prioritize pain assessment for surgical clients before clients with chronic illness. Give prescribed medications to all clients with outward expressions of pain. Rationale The priority action, consistent with TJC pain standards, includes assessing all clients for pain, the fifth vital sign, which is best determined with a pain scale (A). Although objective data (B) are valuable in using prescriptions for a client in pain, all clients, including those with no pain, should be assessed. A client with acute pain in the early postoperative phase does not necessitate prioritized assessment (C) over other clients with chronic pain or end- of-life distress. A client's outward expressions of pain should be validated with a client's lOMoAR cPSD| own subjective assessment of pain intensity and duration and the need for analgesic (D). A client with deep partial-thickness and full-thickness burns of the face and chest is receiving wound care using the "open method." The plan of care includes the nursing diagnosis, "Risk for infection related to impaired tissue integrity." Based on the expected outcome, "Client remains free of infections," which nursing intervention should the practical nurse (PN) implement? Wear gown, cap, mask, and gloves during direct client care. Restrict visitors in order to prevent wound contamination. Use sterile water for debridement in the hydrotherapy tank. Apply sterile dressings after debridement of burn wounds. Rationale The burn area is exposed and an aseptic environment is needed to prevent contamination and infection. Protective isolation precautions should be implemented during direct client care and wound care which should include wearing gown, cap, mask, and gloves. The other options are not required. The practical nurse provides information to a client about collecting a 24-hour urine specimen. Which statement indicates the client needs additional information? "I should continue to take my prescribed heart medicines." "At the beginning of the test, I should add the preservative to the container." lOMoAR cPSD| "I should begin the collection with the first voided specimen when I get up in the morning." "At the end of the 24 hours, I should urinate and add this last specimen to the container." Rationale The 24-hour urine collection specimen starts when the client first arises, discarding the first voided specimen, and notes the start time of urine collection. During a prenatal visit, expectant parents ask the practical nurse (PN) how to safely transport a newborn home in a car seat. What information should the PN provide? The car seat should be secured in the front seat using the seatbelt. The chest harness should slide over the newborn's abdomen. A car seat should be in the rear facing position in the back seat. An infant should be elevated at a 60 degree angle while in the car seat. Rationale Infants should travel only in federally approved, rear-facing safety seats secured in the rear seat from birth to 20 pounds and to 1 year of age. The other options are inaccurate. Which client should the practical nurse (PN) identify as the priority for a focused assessment? Older female with pneumonia who is newly confused to person. Adult male who is receiving an IV infusion reports his arm is cold. lOMoAR cPSD| Older male with serum potassium of 3.2 mEq/L on first postoperative day. Adult female with white cell count of 9,900 mm3 who has pyelonephritis. Rationale A new onset of change in a client's mental status (A) is often related to poor perfusion and cerebral oxygenation and should be assessed first. (B and C) should be assessed next. (D) is an expected finding with infection. The practical nurse (PN) is administering a dissolved medication via a nasogastric tube (NGT). After putting on gloves and attaching the irrigation syringe to the NGT, in which order should the PN implement the actions? ( Arrange from first on top to last on the bottom.) 1. 2. 3. 4. Rationale The next step is to pinch the tubing as tap water is added to the syringe barrel to flush the NGT and ensure its patency. The tubing should be released slowly to allow the solution to flow by gravity instillation. During the instillation of any solution, such as flushed water, Pinch the tubing to pour 15 to 30 ml of tap water in the syringe barrel. Release the tubing slowly to allow the solution to flow. Observe the client for indications of intolerance during instillation. Add the medication solution after pinching the tubing. lOMoAR cPSD| liquid medication, or formula, into an NGT, the client should be observed for signs of intolerance. The tubing should be pinched to prevent air from entering the stomach and to control the flow of the medication as it is added. Which nursing action for a client who was bitten by a black widow spider is within the scope of practice of the practical nurse (PN)? Provide discharge wound care instructions. Assess for respiratory compromise. Administer intramuscular (IM) tetanus toxoid. Determine degree of tissue destruction. Rationale The administration of IM injections is within the scope of practice for the PN . Although the PN gathers data, assessment , discharge planning, and instruction are the responsibility of the registered nurse (RN). What action should the practical nurse (PN) take when implementing daily focused assessments for this assigned group of 4 clients? Apply a blood pressure cuff on client's forearm when the upper arm cannot be used. Measure a child's length from feet to shoulders using a Broselow tape. Palpate the abdomen prior to auscultation for presence of bowel sounds. lOMoAR cPSD| Dispose of the gastric residual volume after aspirating the client's nasogastric tube. Rationale Blood pressure cuff placement on the forearm and calf can be used to obtain an accurate reading when a cuff cannot be placed on the upper arm. Which client information determines the best assignment for the practical nurse (PN)? Client who takes spironolactone has a serum potassium of 5.9 mEq/L. Client with dependent edema is scheduled for discharge to home care. Client who is admitted in the morning is having severe vomiting and diarrhea. Client with a non-tunneled central catheter has severe fluid volume deficiency. Rationale Non-complex client acuity determines client care assignments that should be aligned with the PN's scope of practice. The PN should be assigned to a stable client with residual dependent edema who is preparing for discharge. Clients with complex diagnosis and higher acuity would require the expert skills of the RN. What action should the practical nurse implement to facilitate speech for a client who has a fenestrated tracheostomy tube? Show the client how to use a tracheostomy plug. Determine the client's ability to swallow. lOMoAR cPSD| Remove the inner cannula. Give oxygen at 6 L/minute via tracheostomy collar. Rationale A fenestrated tracheostomy tube has an opening or hole on the posterior aspect of the outer cannula that allows airflow over the vocal cords and speech in a client who is spontaneously breathing. A fenestrated tube does not have a cuff, so the client's risk for aspiration should be determined. Rank the sequence of physiological changes that a newborn must initiate and adapt to extrauterine life after Cesarean delivery? (Arrange in the order from most critical on top to least on the bottom.) 1. 2. 3. 4. Rationale The most critical physiological adaptation of a newborn at birth is the establishment of respirations. Following the establishment of respirations, heat regulation is critical to newborn survival. The cardiovascular system changes after birth are the result of fetal respiration that reduces pulmonary vascular resistance to the pulmonary blood flow and initiates fetal circulatory changes. The infant relies on passive immunity received from the lOMoAR cPSD| mother for the first 3 months of life, which is followed by the infant's immunological responses to microbial exposure. Which finding should the practical nurse report that is the first indication a child with a tracheostomy is experiencing respiratory distress? Cyanosis. Restlessness. Sternal retractions. Crowing respirations. Rationale Unless respiratory arrest occurs suddenly, signs of hypoxemia and hypercapnia are usually subtle and become more obvious as respiratory distress progresses. A child with a tracheostomy may develop airway obstruction from increased airway secretions, which decreases cerebral oxygenation, initially causing restlessness (B), and should be reported immediately. (A, C, and D) are clinical manifestations of severe hypoxia. The practical nurse (PN) is reviewing the use of a new digital thermometer with a group of unlicensed assistive personnel (UAP). Which indicator should the PN use to best evaluate that the UAPs understand the use of the thermometer? UAPs who score 100% on a written test are competent. UAPs have no questions and indicate understanding. Randomly-chosen UAPs state step-by-step directions. lOMoAR cPSD| UAPs are repeatedly observed using equipment correctly. Rationale The best evaluation of a skill, such as use of a digital thermometer, is correct performance of the skill during return demonstration (D). (A and C) indicate cognitive learning, but (D) is the best indicator of safe practice. (B) does not ensure the skill can be performed correctly. A female client who is newly diagnosed with Type 2 diabetes tells the practical nurse (PN) that she hates to exercise and asks whether just following her 1000-calorie diet will control her diabetes. Which response should the PN provide that offers the best information? To ensure an increased energy and a sense of well-being, diet and exercise should be balanced. Exercise facilitates weight loss and decreases peripheral insulin resistance. To improve cardiovascular and respiratory fitness, a regular routine for exercise should be practiced. A routine pattern for meal scheduling is needed for tight glucose control. Rationale Exercise increases insulin sensitivity and has a direct effect on lowering the blood glucose levels. Dietary compliance and regular exercise contribute to weight loss, which also decreases insulin resistance (B). While (A, C, and D) are accurate, (B) provides the best information for client compliance. Which information related to a client's history of benign lOMoAR cPSD| prostatic hypertrophy (BPH) should the practical nurse (PN) report to the healthcare provider? Change in bowel movements. Persistent lower back pain. White penile discharge. Difficulty with urination. Rationale An increase in the size of the prostate gland caused by BPH compresses the urethra, resulting in difficulty initiating the urinary stream. This should be reported to the healtcare provider. The practical nurse (PN) is reviewing the medication dosage instructions with a parent whose child is taking levothyroxine (Synthroid). What statement reveals that the parent understands the correct procedure? "I don't give the medication on the weekends." "I give the medication at 8:00 am every day." "I am using a different brand now because it costs less money." "I stopped giving the medication because my daughter was losing her hair." Rationale A child with hypothyroidism should receive Synthroid every day at the same time therefore,stating that she gives the medication at 8:00am everyday indicates correct understanding. The other options indicate the need to teaching. lOMoAR cPSD| A male client diagnosed with schizophrenia reveals to the practical nurse (PN) that voices have told him he is in danger. He believes he is safe only if he stays in his room and wears the same clothes. He goes on, "They're so loud they frighten me. Don't you hear them?" What is the best response for the PN to provide? "I know these voices are very real to you, but I don't hear them." "Tell me more about the voices and if they are men or women." "You're safe in the hospital and nothing will happen to you." "You should get out of your room so you don't hear the voices." Rationale When asked to validate the hallucination, the PN should respond with the reality that the nurse is not experiencing the same stimuli as the client (A). Although asking the client about the content of a hallucination provides information about directions for self-harm, (B)is not relevant. (C) negates the client's feelings and his reality of the hallucination. (D) is non-therapeutic and ineffective. A client with a common cold is seeking treatment at the health clinic. What information should the practical nurse (PN) reinforce to reduce the spread of infection to family members? Wash hands after each use of a tissue for nasal drainage. Use a dishwasher for all personal dishes and utensils. Recommend wearing a mask until all cold symptoms subside.