CPNRE Practice Questions & Answers, 100% Accurate, Graded A+. Verified.

CPNRE Practice Questions & Answers, 100% Accurate, Graded A+. Verified. The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? a. Prepare the medication using ...

CPNRE Practice Questions & Answers, 100% Accurate, Graded A+. Verified. The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? a. Prepare the medication using a 25-gauge, ½ inch needle b. After injecting the needle, aspirate and observe for blood c. After removing the needle, massage the area gently d. Administer the medication in the client's "love handles" Prepare the medication using a 25-gauge, ½ inch needle Knowledge: The nurse should NOT aspirate for blood when administering heparin because this can damage surrounding tissue and cause bruising. The nurse should not massage after injecting heparin because this may cause bruising or bleeding. Heparin is administered in the abdomen at least 2 inches from umbilicus-best practice. The nurse is administering morning medications on a medical floor. Which medication should the nurse administer first? a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS d. Lasix, a diuretic, to a client with hypertension a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus (can be administered within the 30-minute acceptable time frame) c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS -pain medication is a priority, but it can be administered after the sliding scale d. Lasix, a diuretic, to a client with hypertension- can be administered within the 30-minute acceptable time frame Regular insulin is administered prior to meals; therefore, this medication should be administered. Critical Thinking Which data would indicate that the antibiotic therapy has been successful for a client diagnosed with bacterial pneumonia? a. The client's hematocrit is within normal range b. The client is expectorating thick green sputum c. The client's lung sounds are clear to ausculatation d. The client has complaints of pleuritic chest pain. a. The client’s hematocrit is within normal range- does not indicate client response b. The client is expectorating thick green sputum- symptom of pneumonia c. The client’s lung sounds are clear to ausculatation d. The client has complaints of pleuritic chest pain.— symptom of pneumonia The symptoms of pneumonia includes crackles and wheezes, rhonchi in the lung fields. Clear lungs indicate an improvement in the pneumonia and that the medication is effective. Application The nurse is administering Humalog at 0730 to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? a. Ensure the client eats at least 90% of the lunch tray b. Do not administer unless the breakfast tray is in the client's room c. Check the client's blood glucose level 1 hour after receiving the insulin d. Have 50% dextrose in water at the bedside for emergency use. a. Ensure the client eats at least 90% of the lunch tray—insulin will not be working 4-5 hours after being administered b. Do not administer unless the breakfast tray is in the client’s room c. Check the client’s blood glucose level 1 hour after receiving the insulin—glucose level should be checked prior to administering d. Have 50% dextrose in water at the bedside for emergency use.—this is administered when a client is unconscious secondary to hypoglycemia, and should not be kept at the bedside. Orange juice or some form of simple glucose can be kept at the bedside. Application: The insulin peaks in 15-20 minutes after being administered; therefore, the meal should be at the bedside prior to administering this medication The client has a severe anaphylactic reaction to insect bites. What priority discharge intervention should the nurse discuss with the client? a. Wear an insect repellent on exposed skin b. Keep prescribed antihistamines on their person c. Keep an EpiPen in the refrigerator at all times d. Wear a MedicAlert identification bracelet a. Wear an insect repellent on exposed skin —appropriate intervention, but if the client has an insect bite, the repellent will not prevent anaphylaxis, therefore, not priority intervention b. Keep prescribed antihistamines on their person —used with anaphylaxis, but it takes at least 30 minutes to work, therefore not a priority medication c. Keep an EpiPen in the refrigerator at all times —keeping medication in the refrigerator does not allow it to be available to the client at all times. d. Wear a MedicAlert identification bracelet Application: Bracelet indicates the client is at risk for an anaphylactic reaction; therefore, this is the priority intervention. The client's mother contacts the clinic regarding medication administration stating, "My daughter cannot swallow this capsule. It's too large." Investigation reveals that the medication is a capsule marked SR. The nurse should instruct the mother to: a. Open the capsule and mix the medication with apple sauce b. Crush the medication and administer it with a glass of liquid c. Call the pharmacist and request a change to a different medication d. Stop the medication and inform the physician d. Stop the medication and inform the physician Application: SR means sustained released. These medications cannot be altered. In answers A and B, crushing or opening the capsule is not allowed. The best response would be to inform the prescriber (the doctor) immediately The client calls the nursing station and requests pain medication. When the nurse enters the room with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which action should the nurse administer first? a. Administer the client's prescribed pain medication b. Assess the client's perception of pain on a 1-10 scale c. Wait until the visitors leave to administer any medication d. Check the MAR to see if there is a nonnarcotic medication ordered a. Administer the client’s prescribed pain medication —should not administer pain medication until after assessing the client’s pain b. Assess the client’s perception of pain on a 1-10 scale c. Wait until the visitors leave to administer any medication —should assess client whether the client has visitors or not d. Check the MAR to see if there is a nonnarcotic medication ordered —nurse should assess the client’s pain first Application: first action is to always assess the client in pain to determine if client is having a complication that requires medical intervention rather than PRN medication. The client in hypovolemic shock is receiving normal saline by rapid intravenous infusion. Which assessment data would warrant immediate intervention by the nurse? a. The client's blood pressure is 89/48 b. The client's pulse oximeter reading is 95% c. The client's lung sounds are clear bilaterally d. The client's urine output is 120 mL in 3 hours a. The client’s blood pressure is 89/48 b. The client’s pulse oximeter reading is 95% --normal finding c. The client’s lung sounds are clear bilaterally—normal finding d. The client’s urine output is 120 mL in 3 hours—normal finding Application: low blood pressure reading for a client in hypovolemic shock. A B/P less than 90/60 warrants intervention by the nurse and indicates that fluid resuscitation is not effective. Which intervention should the nurse implement when administering a medication via the intradermal route? a. Insert the needle with the bevel up at 15-degree angle in the skin b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle c. Bunch the skin between the thumb and index finger of the nondominant hand d. Quickly inject the medication as to not form a wheal or bleb a. Insert the needle with the bevel up at 15-degree angle in the skin b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle —wrong syringe (need tuberculin syringe), wrong gauge, and wrong needle c. Bunch the skin between the thumb and index finger of the nondominant hand---skin should be spread taut, not bunched d. Quickly inject the medication as to not form a wheal or bleb—medication should be injected slowly to form a wheal or bleb Knowledge: A is the correct way to administer intradermal medication The charge nurse is observing the primary nurse administering otic drops to a 2-year-old child by pulling down and back on the auricle. Which action should the charge nurse take? a. Stop the primary nurse and ask the nurse to step out of the room b. Demonstrate inserting the otic drops by pulling up and back on the auricle c. Take no action because this is the correct way to administer the ear drops d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse a. Stop the primary nurse and ask the nurse to step out of the room b. Demonstrate inserting the otic drops by pulling up and back on the auricle—correct way for adults c. Take no action because this is the correct way to administer the ear drops d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse Knowledge: This is the correct way to administer eardrops to a child younger than 3. This is done because of the short Eustachian tube of a child. The charge nurse need take no action The nurse prepared 2 mg of morphine for a client who is complaining of pain. When the nurse enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain pill." Which action should the nurse take? a. Explain that the medication must be administered because it has been drawn up b. Ask another nurse to watch the medication being wasted into the sink c. Place the syringe in the sharps container in the client's room— d. Notify the pharmacy that a narcotic was not administered to the client a. Explain that the medication must be administered because it has been drawn up —client has the right to refuse medication; therefore; the nurse cannot force the client to take the med. b. Ask another nurse to watch the medication being wasted into the sink c. Place the syringe in the sharps container in the client’s room—legally the nurse must have someone witness the narcotic being wasted d. Notify the pharmacy that a narcotic was not administered to the client—does not need to be notified Application: Correct procedure as per CNO medication standards of practice The nurse is preparing to adminster 3 mL of a medication intramuscularly to an adult client in the clinic. Which muscle is the best site to administer the medication? a. The deltoid muscle b. The dorsogluteal muscle c. The ventrogluteal muscle d. The vastus lateralis muscle a. The deltoid muscle —1-2 mL max. at this site, muscle is small b. The dorsogluteal muscle— not recommended because the sciatic nerve may be injured if landmarking is improper c. The ventrogluteal muscle d. The vastus lateralis muscle— can be used, but is more painful Knowledge: site of choice is C, free of major nerves and adipose tissue to ensure medication goes in the muscle. It is also a larger mass of muscle. The nurse is administering medications through a gastrostomy tube (GT). Which intervention should the nurse implement first? a. Place the crushed pills in the gastrostomy tube. b. Flush the gastrostomy with at least 30 mL of tap water c. Use the plunger to push the medication into the GT d. Clamp the gastrostomy tube closed. a. Place the crushed pills in the gastrostomy tube.—Not first intervention b. Flush the gastrostomy with at least 30 mL of tap water c. Use the plunger to push the medication into the GT- not first intervention d. Clamp the gastrostomy tube closed.— performed after medication is administered Knowledge: Nurse should first flush the GT with tap water to ensure it is patent before putting any medication into the GT. The charge nurse is making rounds on the clients and notices the primary nurse left a medication cup with three tablets at the client's bedside. Which action should the charge nurse implement? a. Administer the client's medications b. Remove the medication cup from the room c. Request the primary nurse come to the room d. Leave the cup at the bedside and talk to the primary nurse a. Administer the client’s medications—charge nurse cannot administer without verifying medications against MAR b. Remove the medication cup from the room c. Request the primary nurse come to the room—charge nurse should not correct the primary nurse in front of client d. Leave the cup at the bedside and talk to the primary nurse Application: The nurse should take the medication cup back to the medication room and discuss this situation with the primary nurse. Medications should never be left at the bedside. 1. The client in end-stage renal disease is receiving oral Kayexalate. Which assessment data indicates the medication is not effective? a. The client's serum potassium level is 5.8 mEq/L b. The client's serum sodium level is 135 mEq/L c. The client's serum postassium level is 4.2 mEq/L d. The client's serum sodium level is 147 mEq/L a. The client’s serum potassium level is 5.8 mEq/L b. The client’s serum sodium level is 135 mEq/L —does not alter sodium levels (not used for this) c. The client’s serum postassium level is 4.2 mEq/L—normal level d. The client’s serum sodium level is 147 mEq/L (see above) Application: Kayexalate is a medication used to decrease potassium levels. A is an elevated level, therefore, medication is not effective. Which of the following interventions would be a priority in the plan of care for the person with pulmonary emphysema? (Select all that apply) a. Low flow oxygen via face mask b. Intravenous aminophylline c. Maintain hydration status d. Intravenous ampicillin therapy b. Intravenous aminophylline c. Maintain hydration status Application Question: Since emphysema is a chronic disorder, the patient will be required to wear oxygen continuously, therefore nasal canula is the best way to deliver the low levels of oxygen. Aminophylline is a bronchodilator used as maintenance therapy. Hydration is necessary, but not overhydration. Ampicillin therapy is not considered a typical intervention in the management of emphysema. The practical nurse enters Mrs. Stem's room to administer the 0800 Hours insulin dose. Mrs. Stem states , "That is not my usual dose of insulin. " How should the nurse respond to Mrs. Stem? a. "Let me check the medication order again and I'll be back in a few minutes." b. "I'll check with my colleague, who is right here to see if this is the right dose." c. "I saw your insulin order about 1 hour ago and this what the physician ordered." d. "Mrs. Stem, I know what I am doing and you should trust me, this is the correct dose." a. “Let me check the medication order again and I’ll be back in a few minutes.” APPLICATION QUESTION--According to the CNO compendium –medication standards---YOU SHOULD ALWAYS CHECK/VALIDATE ANY MEDICATION /ORDER THAT THE PATIENT THEMSELVES QUESTIONS. “BEST PRACTICE” Mrs. Soh, 65 years old, is 3 days postoperative. She is experiencing nausea and vomiting. What should the nurse do? a. Place bed in semi-Fowler's (45 degrees) b. Document client condition c. Auscultate bowel sounds d. Provide a glass of water c. Auscultate bowel sounds CRITICAL THINKING QUESTION--. Yes, you will document this event, but you would manage the patient first in this case. Complete an assessment, then intervene. Bowel sounds are one aspect of an assessment of peristalsis. This will help determine if the intestines are functioning, and rule out bowel obstruction or other disorders. A 19-year-old with acute asthma has come into the E.R in acute respiratory distress. His breath rate is 44 breaths/minute. Which of the following interventions should the nurse anticipate first? a. Obtain a complete health history b. Administer bronchodilator via nebulizer c. Provide emotional support to the client d. Apply a cardiac monitor to the client b. Administer bronchodilator via nebulizer Critical Thinking Question: Follow Protocol ABC’s First, then Nursing Process. In this case, it is an emergency, therefore we follow ABC’s. The patient is experiencing an acute asthma attack, we will administer bronchodilator to open up the airway. Once the acute phase is over, we can consider the other interventions. Which one of the following best describes the concept of Routine Precautions (formerly Standard Precautions? a. It is a method of infection control used only when the client tests positive for a communicable disease. b. It is a method of sterilization that is followed in emergency and high-risk clinical situations. c. It is a process where soiled articles are separated from clean hospital supplies. d. It is a system of generic infection control practices for all clients. d. It is a system of generic infection control practices for all clients. KNOWLEDGE QUESTION--BEST DESCRIPTION—THE OTHER RESPONSES ARE FALSE Mrs. Albiani, 72 years old, has pneumonia. What assessment should the nurse expect to find during auscultation? a. Wheezing b. Tactile fremitus c. Crackles d. Hyperresonance c. Crackles KNOWLEDGE QUESTION—HYPERRESONANCE IS DUE TO EXCESSIVE AIR ACCUMULATION IN LUNGS. WHEEZING IS DUE TO NARROWED AIRWAY—WHICH COULD DEVELOP LATER WITH ILLNESS, SECONDARY TO THE BUILD UP OF SECRETIONS. What action is best when the nurse observes that a client's drug dosage for an antihypertensive medication is twice the recommended dose for that medication? a. Take the client's vital signs before proceeding with administration b. Take the client's blood pressure every 1-2 hours c. Check with the client to determine how long she has been taking the medication. d. Re-check the dosage on the physician's order sheet. d. Re-check the dosage on the physician’s order sheet. CRITICAL THINKING--Always, Always recheck or verify dosages that are over the recommendation, or are inaccurate. AS PER CNO MEDICATION STANDARDS IN COMPENDIUM Mr. Harrison, 29 years old, is experiencing anxiety following a diagnosis of testicular cancer. What should the nurse do? a. Ask him if he is concerned about not having children b. Encourage him to verbalize his feelings c. Suggest that he talk to his significant other. d. Refer him to a testicular cancer support group. b. Encourage him to verbalize his feelings APPLICATION QUESTION--NURSES ARE ABLE TO LISTEN ANY EXPRESSION OF FEELINGS, IT IS WITHIN THEIR SCOPE OF PRACTICE, THEREFORE, YOU DO NOT NEED TO REFER THIS BOUT OF ANXIETY TO SOMEONE ELSE. A—NON-THERAPEUTIC AT THIS TIME. Ben is a frail, 18-year-old client who is in the end stages of AIDS. He has open areas on his upper and lower extremities. He is having severe persistent pain and is due to receive morphine sulfate (Morphine) 10 mg subcutaneously. Which of the following nursing interventions best applies when the nurse prepares to administer morphine to Ben? a. Inject the morphine in the upper abdomen using a ½ inch needle at 45 degrees. b. Inject the morphine in the upper arm using a 1 inch needle at 45 degrees c. Contact the pharmacist and ask if morphine can be absorbed subcutaneously d. Call the physician and request an alternative route for morphine a. Inject the morphine in the upper abdomen using a ½ inch needle at 45 degrees. CRITICAL THINKING QUESTION—OPEN AREAS ARE LOCATED ON UPPER EXTREMITIES, THEREFORE, DO NOT USE THOSE SITES, 45 DEGREE ANGLE IS BEST FOR UNDERNOURISHED PATIENTS. HE HAS SEVERE PAIN, THEREFORE NEEDS INTERVENTION. A CONSIDERATION FOR THE FUTURE IS POSSIBLY INVESTIGATING FOR A LONGER RELEASE/DURATION PAIN MEDICATION. The nurse is asked by a colleague to witness the wastage of two narcotic tablets that have fallen on the floor. After co-signing the narcotic sheet, the practical nurse sees the colleague put the two tablets in a uniform pocket. Which action must the nurse take? a. Report and document the incident b. Encourage the colleague to attend a self-help group for professionals c. Ignore the incident and observe for further occurrences d. Telephone the discipline committee of the regulatory body. a. Report and document the incident APPLICATION QUESTION---AS PER CNO STANDARDS---CANNOT IGNORE INCIDENT, FOLLOW DUE PROCESS—AT THIS POINT DISCIPLINE COMMITTEE IS NOT THE INITIAL PERSON OF CONTACT, A IS BEST PRACTICE. An elderly male client with alcoholism states that he is thinking of committing suicide and asks that this information be kept confidential. Which one of the following responses is most appropriate for the nurse to make? a. "For your own safety, I have to report this immediately." b. "You are not really serious about this?" c. "Have you spoken to your physician about this?" d. "Are you drinking more now?" a. “For your own safety, I have to report this immediately.” AS PER STANDARDS OF PRACTICE---CONFIDENTIALITY IS TO BE MAINTAINED, WITH THE EXCEPTION OF— HARM TO ONESELF, OR HARM TO ANOTHER. B---MINIMIZES THE EXPRESSION, NON THERAPEUTIC, C— PASSES THE RESPONSIBILITY OFF.---APPLICATION QUESTION The practical nurse is asked to set up an IV infusion of 1,000 ml normal saline for a client. Which one of the following actions is the first responsibility of the nurse? a. Explaining the procedure to the client b. Teaching the client about IV/infusion therapy c. Verifying the physician's order the client d. Assembling the equipment at the client's bedside c. Verifying the physician’s order the client AS PER MEDICATION STANDARDS OF PRACTICE. THIS IS THE FIRST RESPONSIBILITY PRIOR TO PROCEEDING WITH THE PROCEDURE. APPLICATION QUESTION Mrs. Paquette, 65 years old, reports that her toenails are thick, yellow, and difficult to trim. Which one of the following measures by the nurse would best promote wellness? a. Suggest that she visit a foot care specialist for nail trimming b. Demonstrate how to trim her toenails short and rounded at the corners. c. Trim her toenails after they have soaked in hot water for 10 minutes d. Suggest that she use small sharp scissors for trimming her toenails a. Suggest that she visit a foot care specialist for nail trimming Hot water is never recommended, proper water temperature prevents burns. Client’s skin may be accidentally cut. Certain clients are more at risk for infection, depending on medical condition. A Foot Care Specialtist has the instruments and training for proper foot care.-APPLICATION QUESTION The practical nurse is working in a pediatric unit for the first time. The practical nurse's first assignment is to catheterize a 5-year-old female client. The practical nurse has never performed this procedure before. What should the nurse do? a. Refer to a pediatric textbook and perform the catheterization b. Review the procedure and ask another nurse to perform the catheterization c. Take the procedure manual to the room and perform the catheterization d. Review the procedure manual and seek assistance with the catheterization. d. Review the procedure manual and seek assistance with the catheterization. BEST PRACTICE AS PER CNO STANDARDS WOULD BE TO PREVIEW THE PROCEDURE MANUAL AND ASK FOR ASSISTANCE PRIOR TO BEGINNING THE PROCEDURE. TAKING THE MANUAL TO THE ROOM WILL CREATE FEAR AND LACK OF TRUST. PERFORMING THE PROCEDURE, AFTER READING IS NOT SUFFICIENT. –APPLICATION QUESTION The client is receiving infusion therapy of normal saline (0.9%) in the left forearm. On assessment, the nurse notes that the solution is not dripping into the drip chamber. What should the nurse do? a. Check the site, look for obstruction of tubing, and reposition arm b. Check the site, reposition arm, and raise the solution container. c. Close off drip chamber, reposition arm, and re-regulate flow clamp. d. Close off drip chamber, raise the solution, and reposition arm a. Check the site, look for obstruction of tubing, and reposition arm USUAL CAUSES FOR SOLUTION NOT DRIPPING INTO THE DRIP CHAMBER IS INFILTRATION, OBSTRUCTION OR MALPOSITION OF ARM. THE RPN WOULD ASSESS THESE, PRIOR TO REMOVAL OF THE IV.-CRITICAL THINKING The practical nurse witnesses Mrs. Fraser, 72 years old, being handled roughly by another staff member. What should the nurse do first? a. Report the staff member to the nurse-in-charge b. Ensure the physician is informed and document the incident c. Reassign Mrs. Fraser to another staff member d. Discuss the incident with the staff member and document. d. Discuss the incident with the staff member and document. AS PER CNO STANDARDS-YOU WOULD FOLLOW DUE PROCESS AND APPROACH THE STAFF MEMBER RE: BEHAVIOUR. ANY BEHAVIOURS SHOULD BE DOCUMENTED. IF THERE ARE NO CHANGES IN THEIR BEHAVIOUR, THE UNIT MANAGER MUST BE NOTIFIED. REASSIGNING WILL NOT RESOLVE OR ADDRESS THE BEHAVIOUR. THE PHYSICIAN IS NOT THE PERSON TO BE CONTACTED RE: THIS BEHAVIOUR. – APPLICATION QUESTION Mr. McNamara, 48 years old, with Type II diabetes mellitus has been started on insulin. He asks the nurse if he now has Type I diabetes. What is the nurse's best response? a. "No, insulin can be prescribed for people with Type II diabetes." b. "You can have Type I and Type II diabetes at the same time." c. "Would you like to speak with the diabetes educator?" d. "Taking insulin will prevent you from developing Type I diabetes." a. “No, insulin can be prescribed for people with Type II diabetes.” If there is a question that is in your scope of practice to answer, you can answer the question. The client just wants to know if he is now a Type 1 diabetic, which he is not. You can only be A Type one if your pancreas Beta cells were destroyed. In other words Type 2 diabetics cannot be Type 1, so as a nurse, you can tell your patient that information.(accurate information) Knowledge question Mr. Freeborn, 78 years old, has dementia and is in a long-term care unit. As the nurse leads him to the shower, he starts to scream and pulls away. What should the