Medical-Surgical Practice Exam Flashcards 2025

Terms in this set (100) lOMoAR cPSD| 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? Do you understand why you are having surgery? Have you undergone this type of surgery in the past? What do you know about the surgery you are having? What symptoms brought you to the hospital for surgery? What do you know about the surgery you are having? Rationale Although it is the surgeon's responsibility to explain the surgery to the client, it is a nursing responsibility to determine whether the client understands what he has been told about his surgery. Asking open- ended questions is an important step in eliciting what the client understands (C). (A and B) are closed end questions and will elicit one word responses. (D) asks the client to explain the admission related to his need for surgery, but not his understanding about the procedure. lOMoAR cPSD| Right calf is 24 cm and the left calf is 21 cm. Rationale Which finding is most A client with major abdominal surgery is at risk for important for the practical the complication of deep vein thrombosis (DVT) nurse (PN) to explore further due to immobility, dehydration, and manipulation for a client who had a total of major vessels. Unilateral leg swelling (A) is a abdominal hysterectomy and classic sign of a DVT. Not having bowel sounds bilateral oophorectomy one day postoperatively (B) after a major yesterday? abdominal surgery is an expected finding. (C) is not unexpected 3 hours after removal of a urinary Right calf is 24 cm and the left catheter, and the PN should encourage the client calf is 21 cm. to void 6 to 8 hours after the removal of a catheter No bowel sounds or gurgles before taking more aggressive actions. A small auscultated in the abdomen. amount of dried blood is an expected finding (D). No urine output 3 hours after the catheter is removed. Dried blood 3 cm in size noted Which finding for a client who is 1-day on the abdominal dressing. postoperative for a partial thyroidectomy requires immediate follow-up by the practical nurse (PN)? Which finding for a client who High pitched expiratory sound. is 1-day postoperative for a partial thyroidectomy requires Rationale immediate follow-up by the Stridor indicates airway obstruction, which is a practical nurse (PN)? postoperative complication after thyroidectomy (A). (B, C, and D) should be addressed after High pitched expiratory sound. preparing for interventions related to airway Throat pain rated "9." obstruction. Voice is hoarse. Capillary refill is 4 seconds. lOMoAR cPSD| 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? A cool mist humidifier is at the bedside. The salt water solution is dated 3 days ago. A Medic Alert bracelet is on the client's wrist. The client's stoma is covered with a crocheted scarf. The salt water solution is dated 3 days ago. Rationale Salt water solution (B) should be changed daily to prevent bacterial growth. (A, C, and D) are within accepted parameters for care. 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.) Select all that apply Use vinegar solution douche regularly. Avoid wearing tight-fitting jeans. Limit caffeine and alcohol. Void before and after intercourse. Wipe the perineum from front to back. Avoid wearing tight-fitting jeans. Limit caffeine and alcohol. Void before and after intercourse. Wipe the perineum from front to back. Rationale Correct selections are (B, C, D, and E). Voiding before and after intercourse (D), avoiding caffeine and alcohol (C), and not wearing tight jeans (B), as well as wiping the perineal area from front to back (E), reduce UTI risk. Frequent douching (A) does not reduce a client's risk for frequent UTIs. lOMoAR cPSD| The practical nurse is caring Continue to monitor client's blood pressure. for a client who is admitted with signs of possible acute Rationale brain attack (stroke) three The goals for management of a client with a hours ago. The client's blood suspected stroke is continuous monitor of blood pressure is 170/96, regular pressure (C) and neurological deterioration to radial pulse 76 beats/minute, determine eligibility for reperfusion therapy. respirations are nonlabored at Antihypertensives are indicated if the systolic is 11 breaths/minute, and a SpO2 180- 230 or diastolic is 105-140, so (A) is not of 99%. What action is most indicated at this time. (B) is most likely associated important for the PN to with meningeal irritation related to meningitis. implement? Although (D) is a basic component of client care, the priority is monitoring the client's blood Call healthcare provider for pressure. antihypertensive. Assess the client for Brudzinski's sign. Continue to monitor client's blood pressure. Monitor client's IV fluid intake and urine output. A client with cholelithiasis is Hard, rigid abdomen. admitted with jaundice due to obstruction of the common Rationale bile duct. Which finding is As bile accumulates due to obstruction of the most important for the common bile duct, the gallbladder distends and practical nurse to report to can perforate, which is manifested by a distended, the healthcare provider? hard, rigid abdomen (C) that should be reported immediately to the healthcare provider. Radiating Pain radiating to the right pain (A) and clay-colored stool (B) are shoulder. manifestations associated with obstructive Clay-colored stool. jaundice due to cholelithiasis. (D) indicates the Hard, rigid abdomen. obstruction of the common bile duct is reduced. Vomiting bile-stained emesis. lOMoAR cPSD| Smooth, beefy-red oral cavity. Paresthesia of hands and feet. Which findings should the practical nurse identify in a Rationale client with anemia due to a Correct choices are (B and D). Vitamin B 12 vitamin B 12 deficiency? deficiency anemia is due to a dietary deficiency or failure to absorb vitamin B12 from the intestinal Select all that apply tract as a result of partial gastrectomy or Gradual weight gain. pernicious anemia. Manifestations of pernicious Smooth, beefy-red oral cavity. anemia include glossitis (a smooth, beefy-red Macrocytic red blood cells tongue) (B), fatigue, paresthesia (D), pallor and (RBC). jaundice, and weight loss, not (A). The results of a Paresthesia of hands and feet. complete blood count (CBC) that show macrocytic Leukopenia. anemia (C), leukopenia (E) and thrombocytopenia are indicative of bone marrow failure, not vitamin B12 deficiency. An older client with Corrects vision for reading and close work. presbyopia receives a prescription for corrective Rationale lenses. Which information Due to aging of the lenses and loss of elasticity, should the practical nurse presbyopic changes reduce the lenses' ability to provide that explains the accommodate, which makes close vision blurry. expected results of the Corrective lenses improve visual acuity for reading corrective lenses? and in close work (C). (A, B, and D) are inaccurate. Helps to sharpen distance vision. Improves both near and distance vision. Corrects vision for reading and close work. Assists with bilateral accommodation. lOMoAR cPSD| 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.) 3. 4. incontinence. 3. Apply pads to the bedside rails. 4. Rationale During a tonic-clonic seizure (grand mal), the PN should maintain the client's airway. Next, the client should be protected from injury by padding the side rails. Observation of the client's behaviors, such as incontinence, should be noted during a seizure. Minimal stimulation should be maintained during the post-ictal phase to prevent precipitation of subsequent seizures. lOMoAR cPSD| 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? abnormal IOP readings. used on the eye surface. Rationale Pain sensation is eliminated by the use of a topical ophthalmic anesthetic (B) placed in the conjunctival sac prior to the placement of a tonometer when measuring IOP for glaucoma, which is a common cause of blindness if early treatment is not implemented. (A, C, and D) do not provide the client with specific measures taken to prevent discomfort during the procedure. lOMoAR cPSD| 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? Loss of calcium in the bones causes the change. Bones get shorter with age due to wear and tear. Less fluid in each of the disks between the vertebrae occurs with degeneration. It is a combination of wear and tear and calcium loss that causes the change. It is a combination of wear and tear and calcium loss that causes the change. Rationale A biological theory of aging includes the wear- and-tear theory, which explains that after repeated use and damage, body structures and functions wear out because of stress. A normal spine at 40 years of age and osteoporotic changes at 60 and 70 years of age can cause a loss of as much as 6 inches in height. Small losses in the thickness of each of the intervertebral disks, which results from changes in disk consistency, erosion, and osteoporosis, can lead to significant changes in height (D). Calcium changes (A) and wear and tear (B and C) alone do not support significant height loss in aging, but a basic explanation of disk degeneration that combines several factors provides the client with the best information. lOMoAR cPSD| 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? Rationale Removal of a cataract results in restoration of vision with corrective lenses based on the client's underlying error of refraction and retinal integrity. (A and D) are vague and do not focus on the client's fear and specific treatment. (B) is incorrect. sight in both of eyes. Nothing can be done once corrective lens implants or glasses. immediately. lOMoAR cPSD| Absence of blood in the stool. Rationale In burns, Curling's ulcer, a type of gastroduodenal A client with major burns is stress ulcer, is caused by a generalized stress receiving cimetidine response resulting in decreased production of (Tagamet). Which finding mucus and increased gastric acid secretion, which should the practical nurse can cause epigastric pain, gastric ulceration, and (PN) obtain to best evaluate bleeding. Cimetidine (Tagamet), a histamine the effectiveness of the blocker, reduces gastric acid secretion and is used medication? for prevention of Curling's ulcers associated with severe trauma, such as major burns. Absence of Soft, non-tender abdomen. blood in the stool (D) or the occurrence of black, Change in stool frequency. tarry stool indicates the medication is effective. Hyperactive bowel sounds. Although abdominal findings (A), change in stool Absence of blood in the stool. frequency (B) or bowel sounds (C) provides information about the effectiveness of therapy, the best evaluation of the prevention of GI distress and ulceration is the absence of blood in the stool. A client who was hit in the Reports the hospital room is an office. head with a baseball is admitted to the hospital for Rationale observation. Which finding The client's confusion about the hospital requires the practical nurse surroundings is an early sign of a change in (PN) to follow-up with further mental status, which is consistent with findings assessment? associated with an increased intracranial pressure (D). (A and B) are normal findings. A headache is A negative Babinski reflex. an expected finding due to trauma (C) and is not Pupils respond to light equally. an indication of intracranial pathology. Headache rated "8" on a scale of 0-10. Reports the hospital room is an office. lOMoAR cPSD| While completing preoperative preparation for a client admitted for same-day surgery, what evaluation statement should the practical nurse identify as an important outcome? Reports optimal rest in the hours before surgery. Asks questions regarding the surgical experience. Leaves the nursing unit for the surgical department on time. Reads all surgical literature before the operation takes place. Asks questions regarding the surgical experience. Rationale Preoperative preparation should be planned to allow the client and family time to ask questions and receive appropriate feedback (B). (A, C, and D) are not the most important client outcomes of preoperative care. A male client with peptic ulcer Notify the healthcare provider. disease complains of feeling weak and dizzy. The practical Rationale nurse (PN) observes that the Peptic ulcer perforation can cause hemorrhage. client is diaphoretic, has a firm The client is manifesting signs of hypovolemic abdomen, thready pulse at shock, a life-threatening emergency that requires 104 beats/minute, and blood intervention, so the healthcare provider should be pressure of 90/50. Which notified immediately (D). (A, B, and C) delay action should the PN obtaining life-saving prescriptions. implement? Place the client in a left sidelying position. Obtain vital signs every 2 hours. Increase the client's oral fluid intake. Notify the healthcare provider. lOMoAR cPSD| A client who is 2-days Metabolic alkalosis. postoperative for abdominal surgery has a nasogastric Rationale tube (NGT) to low continuous The continuous gastric suction and the fluids the suction. The client tells the client drank increase the washing out gastric practical nurse (PN) his mouth hydrochloric acid, which places the client at risk is so dry that he has been for metabolic alkalosis (B). (A, C, and D) are drinking water to quench his unlikely with gastric suction. thirst. Which potential imbalance should the PN monitor for development in the client? Fluid volume excess. Metabolic alkalosis. Hyperkalemia. Hypercalcemia. Which client should the An older female who does not use estrogen practical nurse consider at replacement. greatest risk for bacterial cystitis? Rationale Postmenopausal women who do not use hormone A middle-aged female who has replacement therapy are at an increased risk for never been pregnant. bacterial cystitis because of changes in the cells of An older female who does not the urethra and vagina (B). (A and C) are not use estrogen replacement. relevant. Urinary tract infections (UTI) are An older male with heart reported in 3% of men on sildenafil (Viagra) (D) failure. compared to the incidence of UTI in A male who uses sildenafil postmenopausal women. (Viagra). lOMoAR cPSD| Which finding prompts the practical nurse (PN) to check the nasogastric tube (NGT) placement? The client has vomited. The pH of aspirated fluid is 6.5. The fluid has a grassy green appearance. The abdomen is distended. The client has vomited. Rationale A NGT can become displaced with vomiting (A) and NGT placement should be verified. The pH of fluid aspirated from the stomach should be 5 or lower, but does not impact placement (B). Fluid aspirated from the stomach can have a grassy green, brown, or clear, mucoid-flecked appearance (C). (D) is not an uncommon finding for a client with a NGT. 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? Dizziness when changing position. Reports urgency with urination. Sharp chest pain with arm movement. Sleeps with two additional pillows. Sleeps with two additional pillows. Rationale Clients with worsening HF often require additional pillows to sleep comfortably at night (D) resulting from a deceased cardiac output that causes fluid backup into the alveoli when supine. Since ACE inhibitors can cause postural hypotension, clients should be advised to change positions slowly (A). Lasix can cause urinary urgency (B) when the bladder fills as a result of diuresis. (C) is likely related to muscle strain because the pain is movement-induced and not related to cardiac hypoxia. lOMoAR cPSD| A male client is admitted with Keep the client NPO for possible surgery. lower right abdominal pain for the past two days. During the Rationale focused assessment, the The client's symptoms of prolonged lower right practical nurse (PN) observes abdominal pain accompanied by tenseness and that the client's abdomen is guarding are indicative of possible appendix rigid with tense positioning. perforation and peritonitis. The client is should be Which action should the PN NPO and prepared for possible surgery (D). (A, B, implement? and C) are not indicated. Withhold opioid use that contributes to constipation. Ask the client if he recently ate any gluten products. Determine if the client has biliary colic pain. Keep the client NPO for possible surgery. An adult client with otitis Pain relief after ear drainage begins. media has thick, yellow drainage from the right ear Rationale canal. What additional Otitis media is an infection of the middle ear that findings should the practical creates an increased pressure behind the nurse (PN) expect to identify? tympanic membrane, which can rupture and drain purulent exudate. Acute ear pain (A) that lessens Pain relief after ear drainage when ear drainage occurs is a sign of a ruptured begins. tympanic membrane. (B, C, and D) are not Periauricle skin excoriation. expected findings with otitis media and acute Increased sensitivity to sound. tympanic membrane rupture. Increased pain with movement of the pinna. lOMoAR cPSD| Finger stick glucose level. A client with type 2 diabetes Rationale mellius (DM) presents in the Poor wound healing is often a sign of uncontrolled clinic with a leg laceration that diabetes mellitus, so a fingerstick glucose level has not healed in two weeks. should be obtained first (D). Although (A) should Which client data is most be monitored during diabetic ketoacidosis, the important for the practical priority is to determine the client's glucose level in nurse to collect? response to poor wound healing and possible infection. Vitamin C (B) intake can influence wound Serum electrolyte results. healing, but managing the client glucose level is Use of vitamin C supplements. the priority. Type 2 DM is usually managed with Daily administration of insulin. oral antidiabetic agents, and (C) maybe indicated Fingerstick glucose level. to promote healing based on the client's serum glucose. Which instructions should the Request the use of special hand scanning at practical nurse (PN) reinforce airports. with a client who is preparing Do not lean against the car while the engine is for discharge after placement running. of a permanent pacemaker Keep the regularly scheduled follow-up implant? (Select all that appointments. apply.) Rationale Select all that apply A client who has a permanent pacemaker should Request the use of special receive reinforcement of instructions that prevent hand scanning at airports. malfunction of the pacemaker (A and C). The client Avoid using cellular phones for should implement (D) to ensure that no long periods of time. complications have occurred with the pacemaker. Do not lean against the car (B and E) are not indicated for a client with a while the engine is running. pacemaker implant. Keep the regularly scheduled follow-up appointments. Ingest a consistent amount of leafy green vegetables. lOMoAR cPSD| The practical nurse (PN) is Disturbed body image. reviewing the plan of care for a client scheduled for a Rationale surgical amputation of the left The psychological impact of the removal of a limb lower leg. Which nursing results in a "Disturbed body image" (C), which is diagnosis should the PN use the highest priority after surgery that affects the as the highest priority for this client's ability to cope with walking, adjustment, client after the surgery? and health maintenance. The client's perception of alterations in body image influences how the client Impaired walking. achieves outcomes related to impaired walking (A), Impaired adjustment. impaired adjustment (B), and ineffective health Disturbed body image. maintenance (D). Ineffective health maintenance. The practical nurse (PN) Check the pulse oximeter for a client with receives a report on a group myasthenia gravis. of clients assigned for the day. Which priority assessment Rationale should the PN implement? Myasthenia gravis results in weakness of the upper body muscles, including the muscles involved in Check the pulse oximeter for a swallowing and respirations, so assessing the client with myasthenia gravis. client for adequate oxygenation is essential (A). Assess a client with multiple Bowel and bladder incontinence are anticipated sclerosis for bowel symptoms of multiple sclerosis and are not urgent incontinence. assessments (B). (C) and (D) are important Determine the presence of assessments, but checking the oxygenation level nuchal rigidity in a client with of a patient with the possibility of respiratory resolving meningitis. compromise is most important. Perform Glasgow Coma Scale (GCS) assessment for a client with a concussion. lOMoAR cPSD| The practical nurse (PN) is Minimize exposure to sunlight during therapy. reviewing the side effects Rationale associated with chlopromazine (Thorazine) The most common adverse effects of rectal suppository for a client chlorpromazine (Thorazine) are sedation, with nausea and vomiting. orthostatic hypotension, and anticholinergic Which information should the effects, such as dry mouth, blurred vision, urinary PN review with the client? retention, photophobia, constipation, tachycardia and photosensitivity. Clients should be advised to Limit fresh fruit and dietary minimize unprotected exposure to sunlight (C). The roughage intake. use of a rectal suppository may stimulate Report any signs of urinary peristalsis, but Thorazine is more likely to slow GI frequency. motility, causing constipation, so (A) is not Minimize exposure to sunlight indicated. Information about other anticholinergic during therapy. side effects, such as dry mouth, blurred vision, Eat a balance diet to minimize urinary hesitation, not (B), and tachycardia, should weight loss. be discussed. Weight gain, not (D), is a common side effect. The practical nurse (PN) is Pinpoint rash on upper chest that does not blanch. performing a shift assessment of a client with a fractured left Rationale hip that occurred in a motor The PN should report the presence of petechiae, a vehicle collision 36 hours ago. pinpoint rash that does not blanch (C) that occurs Which finding should the PN due to fat embolism, a complication related to report to the charge nurse? long bone fractures, which can cause respiratory compromise and should be reported to the charge Both feet are cool to the touch. nurse. (B and D) are expected findings related to Pain rated "7" on a scale of 1-10. traumatic injuries and fractures. Additional Pinpoint rash on upper chest assessment is needed to determine the that does not blanch. significance of (A). Ecchymosis 10 mm x 5 mm on left trochanter area. lOMoAR cPSD| What is the priority data that Respiratory pattern and airway. the practical nurse (PN) should obtain for a client with Rationale a cervical spinal cord injury The priority data to obtain for a client with a (SCI)? cervical SCI are respiratory status and airway patency (D). Clients with cervical spine injuries are Mental status and pupil at risk for respiratory compromise due to reaction. impairment of diaphragm movement. (A, B, and C) Heart rate and rhythm. are not the priority. Muscle strength and reflexes. Respiratory pattern and airway. The practical nurse (PN) is Add sterile water to the suction control chamber to caring for a client with a chest the 20 cm mark. tube connected to a closed chest drainage system to Rationale suction at 20 cm of water The amount of suction applied to the chest wall is pressure. The sterile water in regulated by the amount of water in the suction the suction chamber is gently control chamber, not by the amount of vacuum bubbling at the water level of applied to the system. The gentle bubbling in the 15 cm. What action should the suction chamber causes water to evaporate and PN take? must be added periodically to the chamber (B) to the prescribed level of 20 cm. Turning the vacuum Increase the wall vacuum to source higher (A) causes the bubbling to become cause vigorous bubbling in the vigorous and makes the water evaporate faster, suction chamber. but does not increase the amount of suction. An air Add sterile water to the suction leak is considered when there is continuous control chamber to the 20 cm bubbling in the water-seal chamber, which is mark. evaluated by clamping the chest tube momentarily Assess for an air leak after for assessment (C). The client is encouraged to clamping the chest tube with a breathe deeply (D) to facilitate the lung expansion, small hemostat. but it does not affect the amount of negative Encourage the client to pressure. breathe deeply and slowly every 2 hours. lOMoAR cPSD| A client is scheduled for a "My incision will probably be painful." transurethral resection of the prostate (TURP). What Rationale statement by the client reveals Transurethral resection of the prostate (TURP) is to the practical nurse that the performed by inserting a rectoscope through the client needs additional urethra. No incision is made, so the client's information? statement about an incision (C) indicates the need for more information about the procedure. Liberal "I need to drink a lot after oral fluids are often encouraged (A) after surgery surgery." to prevent infection. Postoperatively, urine is "My urine should be red after blood-tinged (B) due to resection and traumatized surgery." urinary membranes. A client with TURP should "My incision will probably be have an indwelling catheter (D) for drainage and painful." bladder irrigation to prevent occlusion of the "I should have a catheter after catheter with blood clots. surgery." During the daily assessment Rales auscultated bilaterally. of a client with emphysema, the practical nurse (PN) Rationale identifies that the client's Barrel chest and pursed-lip breathing are classic chest is barrel-shaped and he signs of chronic obstructive pulmonary diseases is demonstrating pursed-lip (COPD), such as emphysema. The presence of breathing. Which additional bilateral rales (D) indicates that is client has finding requires follow up by pulmonary congestion or an infection which can the PN? easily overwhelm a client with the disease and requires follow up. (A and C) are common findings Pulse oximetry is 90% on room for a client with COPD. (B) is within normal limits air. (norm WBC is 5,000-10,000 mm3 ). White blood cell (WBC) count is 9,900 mm3. Dyspnea when ambulating in the hall. Rales auscultated bilaterally. lOMoAR cPSD| Which information should the practical nurse (PN) reinforce with a client with a tracheostomy who is learning self-feeding? swallowing. Follow each spoon of food with water. consistency. chest when swallowing. Rationale Tilting the chin toward the chest facilitates swallowing and closes the glottis to prevent aspiration by directing food into the esophagus. The other instructions do not reduce the risk of aspiration. Over-inflation of the cuff causes pressure and necrosis on the tracheal wall. lOMoAR cPSD| A male client with metastatic gastric cancer is being discharged home, but the symptoms at home. What action should the practical provide? give at home. be able to give daily care and medications. for the client. Rationale A client with metastatic gastric cancer who is terminally ill often experiences difficulty with emotional needs and physical symptoms that require specialized care during the dying process. Hospice services (D) in the home should be offered to the client and family to assist with both physical care and emotional adjustment with this stage of life and death. (A, B, and C) do not address the concerns voiced by the client and family. lOMoAR cPSD| 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? Rationale The NGT should be assessed for proper functioning if gastric secretions become stagnant in the tube. Determining placement of the tube (C) is the first action. (A, B, and D) are actions that may need to be implemented based on the evaluation of the NGT. suction in the wall outlet. to reinsert a new tube. NGT. saline. lOMoAR cPSD| 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. Drink 2 liters of fluid per day. Encourage visitors to wash hands. Request analgesics as needed. Exercise the affected arm everyday. Rationale Exercise (A) is an important component in the rehabilitation stage following a severe burn to prevent contracture formation, which impairs normal function of the muscle and joints of the arm. Although fluids (B) are important in the initial stage after a severe burn, it is not a key need in rehabilitation in preventing long-term complications. (C) is important in the prevention of infection. (D) may be indicated during convalescence, but exercise is vital to ensure range of motion and prevention of long-term effects of contractures. 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? Reticulocyte count of 1%. Serum ferritin level of 350 ng/ml. International normalized ratio (INR) of 0.9. Total white blood count of 9,000/mm3. International normalized ratio (INR) of 0.9. Rationale Warfarin therapy increases the INR. When the effects of warfarin are no longer present, the i (C). (A, B, and D) are inaccurate. lOMoAR cPSD| 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? bearing stress. Advanced age eventually Poor circulation may cause pain in the lower extremities. Joint damage can occur from Cartilage of the lower extremities is more likely to out. Rationale Osteoarthritis (degenerative joint disease) causes degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone and results from excessive wear and tear to cartilage in weight bearing joints (C). Poor circulation does not affect joint stiffness (B). (A and D) do not provide the client with specific information about his disease. lOMoAR cPSD| A client who has vomiting, No vomiting with oral fluid intake. dysuria, and urinary tract infection (UTI) arrives in the Rationale clinic and receives an IV The client must be able to tolerate oral fluids (B) to antiemetic and a liter of IV maintain hydration and take oral antibiotics at fluids. The healthcare provider home. (A, C, and D) are expected findings of prescribes oral antibiotics for infection and are not criteria for discharge with a the client's discharge. Which prescribed antibiotic regime. finding is essential for the practical nurse to determine before the client is discharged? Temperature below 100.4 F (38 C). No vomiting with oral fluid intake. White blood cell (WBC) count below 13,000 mm3. Minimal dysuria with voiding. Which finding should the Hemoglobin of 10 grams/dl. practical nurse (PN) identify as typical for a client who is Rationale hypoxic? A decreased hemoglobin (B) reduces oxygen carrying capacity, causing tissue hypoxia. (A, C, Temperature of 103 F. and D) are not typical findings of hypoxia. Hemoglobin of 10 grams/dl. PO2 of 80 mmHg. PCO2 of 30 mmHg. lOMoAR cPSD| 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? Rationale Role playing is an effective learning strategy that is useful in introducing and solidifying new coping mechanisms that the client can use. (B, C, and D) identify the client's stressors but are not effective learning activities. Have the client list feelings Discuss with the client the stress. lOMoAR cPSD| Which action should the practical nurse take when handling a sample of cerebrospinal fluid (CSF) collected for diagnostic testing from a client? specimen. Implement standard specimen. transmission. transporting the collection tubes. sample deterioration. Rationale Standard precautions should be implemented for any potential contact with all body fluids (A). (B and C) are not indicated. (D) does not address the concept of safety. lOMoAR cPSD| 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? analysis. impaction. Rationale Findings such as decreased or absent bowel sounds and reports of constipation after barium swallow are indicative of a barium impaction, which can be confirmed by a digital check (D). Although stool analysis confirms the presence of barium, the client is unable to have a bowel movement (A). (B and C) may reduce the risk of constipation, but do not address the consequences of retained barium. lOMoAR cPSD| A male client who is 6 hours Notify the healthcare provider of the changes. post radical nephrectomy has a urine output of 20 ml/hour Rationale and his blood pressure has These findings indicate bleeding and poor renal changed from 134/90 to perfusion, so the healthcare provider should be 100/56 in the past hour. Which notified (A). (B, C, and D) should be implemented, action should the PN but the client needs immediate prescribed implement? treatment from the healthcare provider. Notify the healthcare provider of the changes. Check the urinary catheter for kinks or blockage. Obtain the client's vital signs and output in one hour. Verify the patency and rate of the IV infusion. What is the immediate Check the client's groin. assessment the practical nurse (PN) should implement Rationale for a client who returns to the Cardiac catheterization is most commonly unit after a cardiac accessed using the femoral artery, so it is essential catheterization? to check the groin puncture site (D) and pressure dressing for signs of hemorrhage or hematoma Evaluate color of toes. formation. Although (A, B and C) should be Assess apical pulse. implemented during the postprocedure period, Determine the IV infusion rate. the risk for bleeding from the arterial puncture Check the client's groin. site is the first assessment. lOMoAR cPSD| A male client who is Vomiting unconscious after blunt trauma to the head during a Rationale baseball game is admitted for A client with an epidural hematoma, an arterial observation for possible intracranial bleed, typically manifests epidural hematoma. The client unconsciousness at the scene of the injury is awake and oriented at each followed with lucid intervals of orientation, hourly check and becomes decreasing levels of consciousness, and other more difficult to arouse. Which symptoms, such as vomiting (C) or focal findings, additional finding should the which should be reported. (A, B, and D) are not practical nurse report? indicative of increasing intracranial pressure. Hyperactive gag reflex. Nuchal rigidity. Vomiting. Bounding peripheral pulses. Which client should the 50-year-old with Prinzmetal's angina. practical nurse question a PRN prescription for Rationale sumatriptan (Imitrex) for Imitrex reduces pain and other associated migraine headaches? symptoms of migraine headache by binding to serotonin receptors and triggering generalized 30-year-old with bronchial vasoconstriction, which can cause coronary asthma. vasospasm in clients with Prinzmetal's or variant 40-year-old with diabetes angina (C). (A, B, and D) are inaccurate. mellitus. 50-year-old with Prinzmetal's angina. 60-year-old with chronic kidney disease. lOMoAR cPSD| 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? Auscultate anterior and posterior lung sounds bilaterally. Institute measures to reduce oxygen consumption. Decrease oxygen flow rate to 2 liter/minute and attach pulse oximeter. Verify the oxygen flow rate with the healthcare provider's prescription. Decrease oxygen flow rate to 2 liter/minute and attach pulse oximeter. Rationale The PN should question the flow rate at 6 liters/minute for a client with COPD, which can reduce the respiratory drive and cause respiratory arrest. The first action is to reduce the oxygen flow rate and determine the client's pulse oximetry reading. (A and B) can be implemented after reducing the oxygen flow rate. Although the oxygen flow rate should be verified with the healthcare provider's prescription (D), the client's respiratory drive has been reset by a chronic elevated CO2 level caused by COPD and high levels of supplemental oxygen should not be given. lOMoAR cPSD| A client is receiving a unit of Urticaria on the neck and chest. packed red blood cells (RBC's). Which finding should Rationale the practical nurse (PN) report Urticaria signals an allergic reaction and must be to the healthcare provider? reported to the healthcare provider (D). Blood products are refrigerated prior to infusion, so (A Reports IV infusion feels "cold". and B) are expected findings. (C) is within normal Skin color pale and cool to limits. touch. Heart rate 98 beats/minute. Urticaria on the neck and chest. Palpation of both pedal pulses. Which assessment is most Rationale important for the practical nurse (PN) to implement for a Although complications are uncommon after client who returns from arthroscopic procedures, monitoring for surgery for an arthroscopic neurovascular compromise is most important. repair of the right knee? Neurovascular assessments, such as presence of pedal pulses (C), evaluate circulatory integrity of Evaluation of pain symptoms. tissues that are distal to the surgical site. Although Auscultation of bowel sounds. evaluating the client's pain level (A), bowel Palpation of both pedal pulses. function (B), and temperature (D) are components Observation of body of postoperative care, compromised circulation or temperature. nerve innervation due to the surgery require immediate action to prevent permanent damage to tissues. lOMoAR cPSD| The practical nurse (PN) is Use pursed-lip and abdominal breathing. caring for a client with chronic obstructive pulmonary Rationale disease (COPD). To reduce Pursed-lip breathing used during diaphragmatic or carbon dioxide ( CO 2 ) abdominal breathing (A) provides mild resistance retention in the lungs, which through partially closed lips to prolong exhalation information should the PN and increase airway pressure, which delays airway reinforce? compression and reduces air trapping. Although (B, C, and D) are helpful, a client with COPD should Use pursed-lip and abdominal use this effort with expiration to reduce CO2 breathing. retention caused by the loss of elasticity of the Maintain a sitting position with alveoli. the arms supported. Drink at least 3 liters of fluid daily. Intersperse rest between periods of physical activity. Which action should the Change the transparent dressing every 72 hours. practical nurse (PN) implement to reduce the risk Rationale of infection for a client who is To prevent infection, TPN sterile dressing changes receiving total parenteral should be implemented every 3 to 7 days using a nutrition (TPN)? transparent dressing (C), which allows inspection of the site for signs of redness, swelling, foul odor, Administer antibiotics or purulent drainage. (A and B) are incorrect secondary to the TPN fluid. procedures for TPN. (D) does not address the Replace the peripheral cannula concept of infection control. every 48 hours. Change the transparent dressing every 72 hours. Use a semipermeable dressing on the insertion site. lOMoAR cPSD| 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? A prescribed diuretic can be taken in the morning to reduce night-time voiding. There are no other treatments unless there is evidence of cancer. Practicing pelvic floor exercises can reduce dribbling of urine. An indwelling catheter is sometimes prescribed to alleviate symptoms. An indwelling catheter is sometimes prescribed to alleviate symptoms. Rationale To provide comfort and prevent urinary and kidney damage preoperatively, the insertion of an indwelling urinary catheter (D) can be prescribed to relieve urinary retention caused by the enlarged prostate that is encroaching on the urethra. (A, B, and C) are inaccurate information for the client's condition. lOMoAR cPSD| 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? Observe for side effects, such as an orange discoloration of urine. A vitamin B supplement should be added to the daily medications. TB is contagious until all four medications are completed. The four-drug protocol should be taken concurrently. The four-drug protocol should be taken concurrently. Rationale To prevent resistant strains of tuberculosis, a client with tuberculosis is initially prescribed a four-drug regimen, which requires strict compliance. Information about the concurrent administration of all of the four-drugs in this treatment plan (D) should be reinforced with the client and the healthcare provider notified of the client's past use of the protocol. (A and B) provide additional information for the client, but (D) is the most important information to convey to the client. Although partial use of the medication may be less effective (C), the client's use of the medication must be addressed.