Med-Surg Hesi PN / Exam Questions & Expertly
Verified Answers,
A 70-year-old client status post hip replacement is transferred
to a rehabilitation facility. Which scale should the practical nurse
(PN) identify as the best tool to predict the client's risk for
developing skin breakdown?
a. Braden Scale
b. Morse Scale
c. Aldrete Scale
d. Wong-Baker Face Scale - ...ANSWER✓✓✓a. Braden Scale
The Braden Scale is made up of six subscales: sensory
perception, moisture, activity, mobility, nutrition, and friction and
shear. A hospitalized adult with a score 16 or below or an older
adult with a score of 18 or below is at an increased risk for skin
breakdown.
A client comes to the clinic and reports the presence of a painful
lesion in the genital area; they described it as a blister 2 days
earlier that is now crusty. Which intervention should the
practical nurse (PN) implement first?
,a. Ask the client if they have had unprotected sex.
b. Prepare the client for a culture and sensitivity test of the
lesion.
c. Inform the client this occurrence will have to be reported to
the public health department.
d. Prepare to administer penicillin intramuscularly into the
dorsogluteal area. - ...ANSWER✓✓✓a. Ask the client if they have
had unprotected sex.
Rationale:
These are typical signs and symptoms of herpes simplex virus 2
(HSV2), a sexually transmitted disease (STD), so the PN should
ask the client if they had unprotected sex and if the client has
exposed others to the disease.
A client demonstrated pupillary constriction when a pen light
was shined in their eyes. Which nursing action should the
practical nurse perform?
a. Report the finding to the health care provider.
b. Record the finding on the assessment notes.
c. Assess blood pressure to rule out hypertension.
d. Record that the client has poor vision. - ...ANSWER✓✓✓b.
Record the finding on the assessment notes.
,Pupillary constriction to light is a normal finding and should be
documented in the assessment notes.
A client diagnosed with a brain tumor is receiving radiation beam
treatments to the right frontal area. The practical nurse (PN)
should observe this client for which problem during the early
post-therapy days?
a. Hemiplegia
b. Headache
c. Hearing loss
d. Dysphagia - ...ANSWER✓✓✓b. Headache
Rationale:
Radiotherapy is a local treatment, and most side effects are site-
specific, such as inflammation of surrounding brain tissue,
swelling, headache, and fatigue.
A client diagnosed with a fracture of the left radius has a plaster
cast applied. The nurse has reinforced instructions for drying the
cast over the next 24 hours. Which statement by the client
indicates the teaching was effective?
a. "I will wrap the cast in plastic wrap for 24 hours."
b. "I will support the cast on a firm surface during the night."
, c. "I will not cover it; instead I'll keep the cast surfaces exposed
to circulating air."
d. "I can use a blow dryer on medium setting until the plaster
cast feels dry to the touch." - ...ANSWER✓✓✓c. "I will not cover
it; instead I'll keep the cast surfaces exposed to circulating air."
Rationale:
The nurse should instruct the client to keep the cast exposed to
circulating air and avoid covering it with material that might keep
it moist.
A client diagnosed with a fracture of the left radius has a plaster
cast applied. The nurse has reinforced instructions for drying the
cast over the next 24 hours. Which statement by the client
indicates the teaching was effective?
a. "I will wrap the cast in plastic wrap for 24 hours."
b. "I will support the cast on a firm surface during the night."
c. "I will not cover it; instead I'll keep the cast surfaces exposed
to circulating air."
d. "I can use a blow dryer on medium setting until the plaster
cast feels dry to the touch." - ...ANSWER✓✓✓c. "I will not cover
it; instead I'll keep the cast surfaces exposed to circulating air."
Rationale:
Verified Answers,
A 70-year-old client status post hip replacement is transferred
to a rehabilitation facility. Which scale should the practical nurse
(PN) identify as the best tool to predict the client's risk for
developing skin breakdown?
a. Braden Scale
b. Morse Scale
c. Aldrete Scale
d. Wong-Baker Face Scale - ...ANSWER✓✓✓a. Braden Scale
The Braden Scale is made up of six subscales: sensory
perception, moisture, activity, mobility, nutrition, and friction and
shear. A hospitalized adult with a score 16 or below or an older
adult with a score of 18 or below is at an increased risk for skin
breakdown.
A client comes to the clinic and reports the presence of a painful
lesion in the genital area; they described it as a blister 2 days
earlier that is now crusty. Which intervention should the
practical nurse (PN) implement first?
,a. Ask the client if they have had unprotected sex.
b. Prepare the client for a culture and sensitivity test of the
lesion.
c. Inform the client this occurrence will have to be reported to
the public health department.
d. Prepare to administer penicillin intramuscularly into the
dorsogluteal area. - ...ANSWER✓✓✓a. Ask the client if they have
had unprotected sex.
Rationale:
These are typical signs and symptoms of herpes simplex virus 2
(HSV2), a sexually transmitted disease (STD), so the PN should
ask the client if they had unprotected sex and if the client has
exposed others to the disease.
A client demonstrated pupillary constriction when a pen light
was shined in their eyes. Which nursing action should the
practical nurse perform?
a. Report the finding to the health care provider.
b. Record the finding on the assessment notes.
c. Assess blood pressure to rule out hypertension.
d. Record that the client has poor vision. - ...ANSWER✓✓✓b.
Record the finding on the assessment notes.
,Pupillary constriction to light is a normal finding and should be
documented in the assessment notes.
A client diagnosed with a brain tumor is receiving radiation beam
treatments to the right frontal area. The practical nurse (PN)
should observe this client for which problem during the early
post-therapy days?
a. Hemiplegia
b. Headache
c. Hearing loss
d. Dysphagia - ...ANSWER✓✓✓b. Headache
Rationale:
Radiotherapy is a local treatment, and most side effects are site-
specific, such as inflammation of surrounding brain tissue,
swelling, headache, and fatigue.
A client diagnosed with a fracture of the left radius has a plaster
cast applied. The nurse has reinforced instructions for drying the
cast over the next 24 hours. Which statement by the client
indicates the teaching was effective?
a. "I will wrap the cast in plastic wrap for 24 hours."
b. "I will support the cast on a firm surface during the night."
, c. "I will not cover it; instead I'll keep the cast surfaces exposed
to circulating air."
d. "I can use a blow dryer on medium setting until the plaster
cast feels dry to the touch." - ...ANSWER✓✓✓c. "I will not cover
it; instead I'll keep the cast surfaces exposed to circulating air."
Rationale:
The nurse should instruct the client to keep the cast exposed to
circulating air and avoid covering it with material that might keep
it moist.
A client diagnosed with a fracture of the left radius has a plaster
cast applied. The nurse has reinforced instructions for drying the
cast over the next 24 hours. Which statement by the client
indicates the teaching was effective?
a. "I will wrap the cast in plastic wrap for 24 hours."
b. "I will support the cast on a firm surface during the night."
c. "I will not cover it; instead I'll keep the cast surfaces exposed
to circulating air."
d. "I can use a blow dryer on medium setting until the plaster
cast feels dry to the touch." - ...ANSWER✓✓✓c. "I will not cover
it; instead I'll keep the cast surfaces exposed to circulating air."
Rationale:
