LVN EXIT RETAKE EXAM
A nurse is observing assistive personnel check the tympanic temperature. Which
indication that the AP understands how to perform the procedure.
- The AP pulls the pinna up and back.
- The AP inserts the probe with a straight, forward motion.
- The AP points the probe posteriorly.
- The AP positioned the client facing her. - ANSWER The AP pulls the pinna up and
back.
A nurse is assisting with the care of a client following electroconvulsive therapy for
the use
of the expected finding should the nurse expect 15 min following the procedure.?
- Paresthesia
- Tonic- clonic-seizures.
- Disorientation
- Sleep apnea - ANSWER Disorientation
A nurse is assisting with a prenatal examination of a client who is at 8 weeks of
gestation .
The nurse notes that the client's vagina and vulva purplish color. The nurse should
docket this
finding as which of the following?
- Ballottement
- Chadwick's sign
- Chloasma
- Hagar's sign - ANSWER Chadwick's sign
A nurse is assisting in providing postmortem care to a client who was a devout
follower of
Hinduism. Which of the following request should the nurse anticipate from the client's
family?
- To bury the client's body within 24hr of their death.
- To cremate the client's body pg 25
- To stay with the client's body for 8hr following their death
- To prohibit medical personnel from touching the client's body - ANSWER To
cremate the client's body pg 25
A nurse is reinforcing with a client who has a new diagnosis of COPD. Which of the
following statements by the client indicates understanding of the teaching?
- I should practice pursed-lip breathing exercises.
- I should do aerobic exercises once per day.
- I will consume low protein, low calorie foods.
,- I will increase my fluid intake to 1,700 milliliter per day. - ANSWER I should
practice pursed -lip breathing exercises.
A nurse is contributing to the plan of care for a client who has ascites due to
cirrhosis. Which of the following interventions should the nurse recommend including
in the plan?
- Measure the client's abdominal girth daily.
- Restrict the client's sodium intake to 3 g per day.
- Keep the client's daily protein intake below o.8g/kg
- Position the client supine with legs elevated. - ANSWER Measure the client's
abdominal girth daily.
A nurse is completing documentation in the medical record about a client who fell on
the floor. Which of the following statements should the nurse include in the
documentation?
- The client fell because the assistive personnel did not place non skid slippers on
the client.
- Client stated, I lost my balance and fell when I got out of bed to go to the bathroom.
- An incident report has been completed and sent to risk management.
- The client does not appear to have any injuries resulting from the fall. - ANSWER
Client stated, I lost my balance and fell when I got out of bed to go to the bathroom.
A nurse is assisting with a community health program for caregivers of clients who
have Alzheimer's disease. Which of the following should the nurse include?
- Use written signs to assist the client with locating the bathroom.
- Use confrontation to manage the client 's behavior.
- Limit the number of choices for the client.
- Provider a stimulating environment for the client. - ANSWER Limit the number of
choices for the client.
A nurse overhears two assistive personnel AP in the nurse station discussing a client
who was recently admitted. Which of them should the nurse take?
- Document the event in the client's progress notes.
- Tell the APs to stop the conversation.
- Submit an incident report to the risk manager.
- Inform the client of the APS actions. - ANSWER Tell the APs to stop the
conversation.
A nurse is reinforcing discharge teaching with the caregiver of a client who has
dependent personality disorder. Which of the following instructions should the nurse
include in the teaching?
- Assume responsibility for making the client's decisions.
- Limit the client's social interactions
- Maintain a verbal no harm contract with the client.
, - Encourage the client to be assertive. - ANSWER Encourage the client to be
assertive.
A nurse is caring for a client who is 2 days postoperative following a total bilateral.
mastectomy. The client is tearful and looks away when surgical dressing is removed.
The nurse should place the priority on which of the following actions?
- Providing the client with information on community resources that will strengthen
her coping skills.
- Encouraging the client to write about her feelings in a journal each day.
- Identify the client's perception of the changes in her physical appearance.
- Demonstrating a nonjudgmental attitude toward the client when providing care for
her surgical wounds. - ANSWER Identify the client's perception of the changes in
her physical appearance.
A nurse working in a rehabilitation unit is administering medications to two clients
who have the same name. Which of the following should the nurse use to verify the
identities of each client?
- The names of the clients nearest relatives
- The telephone numbers of the clients.
- The room numbers of the clients
- The diagnoses of the clients - ANSWER The telephone numbers of the clients.
A nurse is reviewing the pain of care for a group of clients. The nurse should identify
that informed consent is required for which of the following procedures?
- Administration of an iron injection using Z- track technique.
- Placement of a central venous catheter.
- Insertion of a nasogastric tube.
- Irrigation of a wound with antibiotic solution. - ANSWER Placement of a central
venous catheter.
A nurse is assisting with the admission of a client who has varicella zoster. Which of
the following interventions should the nurse plan to implement?
- Administer aspirin if the client develops a fever.
- Assign the client to a negative pressure airflow room.
- Initiate contact precautions for the client.
- Have visitors remain at least 0.91 m (3feet) away from the client - ANSWER
Initiate contact precautions for the client.
A nurse is reinforcing teaching with a client who has GERD and a prescription for
pantoprazole. Which of the following statement indicate understanding of the
teaching?
- I have to take this medication on an empty stomach.
- I will need to remain upright for 1 hour after taking the medication.
- I can take antacids at the same time as this medication.?
A nurse is observing assistive personnel check the tympanic temperature. Which
indication that the AP understands how to perform the procedure.
- The AP pulls the pinna up and back.
- The AP inserts the probe with a straight, forward motion.
- The AP points the probe posteriorly.
- The AP positioned the client facing her. - ANSWER The AP pulls the pinna up and
back.
A nurse is assisting with the care of a client following electroconvulsive therapy for
the use
of the expected finding should the nurse expect 15 min following the procedure.?
- Paresthesia
- Tonic- clonic-seizures.
- Disorientation
- Sleep apnea - ANSWER Disorientation
A nurse is assisting with a prenatal examination of a client who is at 8 weeks of
gestation .
The nurse notes that the client's vagina and vulva purplish color. The nurse should
docket this
finding as which of the following?
- Ballottement
- Chadwick's sign
- Chloasma
- Hagar's sign - ANSWER Chadwick's sign
A nurse is assisting in providing postmortem care to a client who was a devout
follower of
Hinduism. Which of the following request should the nurse anticipate from the client's
family?
- To bury the client's body within 24hr of their death.
- To cremate the client's body pg 25
- To stay with the client's body for 8hr following their death
- To prohibit medical personnel from touching the client's body - ANSWER To
cremate the client's body pg 25
A nurse is reinforcing with a client who has a new diagnosis of COPD. Which of the
following statements by the client indicates understanding of the teaching?
- I should practice pursed-lip breathing exercises.
- I should do aerobic exercises once per day.
- I will consume low protein, low calorie foods.
,- I will increase my fluid intake to 1,700 milliliter per day. - ANSWER I should
practice pursed -lip breathing exercises.
A nurse is contributing to the plan of care for a client who has ascites due to
cirrhosis. Which of the following interventions should the nurse recommend including
in the plan?
- Measure the client's abdominal girth daily.
- Restrict the client's sodium intake to 3 g per day.
- Keep the client's daily protein intake below o.8g/kg
- Position the client supine with legs elevated. - ANSWER Measure the client's
abdominal girth daily.
A nurse is completing documentation in the medical record about a client who fell on
the floor. Which of the following statements should the nurse include in the
documentation?
- The client fell because the assistive personnel did not place non skid slippers on
the client.
- Client stated, I lost my balance and fell when I got out of bed to go to the bathroom.
- An incident report has been completed and sent to risk management.
- The client does not appear to have any injuries resulting from the fall. - ANSWER
Client stated, I lost my balance and fell when I got out of bed to go to the bathroom.
A nurse is assisting with a community health program for caregivers of clients who
have Alzheimer's disease. Which of the following should the nurse include?
- Use written signs to assist the client with locating the bathroom.
- Use confrontation to manage the client 's behavior.
- Limit the number of choices for the client.
- Provider a stimulating environment for the client. - ANSWER Limit the number of
choices for the client.
A nurse overhears two assistive personnel AP in the nurse station discussing a client
who was recently admitted. Which of them should the nurse take?
- Document the event in the client's progress notes.
- Tell the APs to stop the conversation.
- Submit an incident report to the risk manager.
- Inform the client of the APS actions. - ANSWER Tell the APs to stop the
conversation.
A nurse is reinforcing discharge teaching with the caregiver of a client who has
dependent personality disorder. Which of the following instructions should the nurse
include in the teaching?
- Assume responsibility for making the client's decisions.
- Limit the client's social interactions
- Maintain a verbal no harm contract with the client.
, - Encourage the client to be assertive. - ANSWER Encourage the client to be
assertive.
A nurse is caring for a client who is 2 days postoperative following a total bilateral.
mastectomy. The client is tearful and looks away when surgical dressing is removed.
The nurse should place the priority on which of the following actions?
- Providing the client with information on community resources that will strengthen
her coping skills.
- Encouraging the client to write about her feelings in a journal each day.
- Identify the client's perception of the changes in her physical appearance.
- Demonstrating a nonjudgmental attitude toward the client when providing care for
her surgical wounds. - ANSWER Identify the client's perception of the changes in
her physical appearance.
A nurse working in a rehabilitation unit is administering medications to two clients
who have the same name. Which of the following should the nurse use to verify the
identities of each client?
- The names of the clients nearest relatives
- The telephone numbers of the clients.
- The room numbers of the clients
- The diagnoses of the clients - ANSWER The telephone numbers of the clients.
A nurse is reviewing the pain of care for a group of clients. The nurse should identify
that informed consent is required for which of the following procedures?
- Administration of an iron injection using Z- track technique.
- Placement of a central venous catheter.
- Insertion of a nasogastric tube.
- Irrigation of a wound with antibiotic solution. - ANSWER Placement of a central
venous catheter.
A nurse is assisting with the admission of a client who has varicella zoster. Which of
the following interventions should the nurse plan to implement?
- Administer aspirin if the client develops a fever.
- Assign the client to a negative pressure airflow room.
- Initiate contact precautions for the client.
- Have visitors remain at least 0.91 m (3feet) away from the client - ANSWER
Initiate contact precautions for the client.
A nurse is reinforcing teaching with a client who has GERD and a prescription for
pantoprazole. Which of the following statement indicate understanding of the
teaching?
- I have to take this medication on an empty stomach.
- I will need to remain upright for 1 hour after taking the medication.
- I can take antacids at the same time as this medication.?
