LPN NCLEX questions & Answers. Graded A+. 100% Approved.

LPN NCLEX questions & Answers. Graded A+. 100% Approved. Which of the following assessment findings could the nurse see in a patient with parkinsonism? (Select all that apply.) a. An abrupt onset of symptoms b. Mu ...

LPN NCLEX questions & Answers. Graded A+. 100% Approved. Which of the following assessment findings could the nurse see in a patient with parkinsonism? (Select all that apply.) a. An abrupt onset of symptoms b. Muscle rigidity c. Involuntary tremors d. Bradykinesia e. Bilateral muscle weakness - ✔✔-b. Muscle rigidity c. Involuntary tremors d. Bradykinesia A patient is receiving carbidopa-levodopa for parkinsonism. What should the nurse know about this drug? a. Carbidopa-levodopa may lead to hypertension. b. Carbidopa-levodopa may lead to excessive salivation. c. Dopaminergic and anticholinergic therapy may lead to drowsiness and sedation. d. Dopaminergics and anticholinergics are contraindicated in patients with glaucoma. - ✔✔-d. Dopaminergics and anticholinergics are contraindicated in patients with glaucoma. The nurse has initiated teaching for a family member of a patient with Alzheimer's disease. The nurse realizes more teaching is needed if the family member makes which statement? a. As the disease gets worse, the memory loss will get worse. b. There are several theories about the cause of the disease. c. Personality changes and hostility may occur. d. It may take several medications to cure the disease. - ✔✔-d. It may take several medications to cure the disease. A patient is taking rivastigmine (Exelon). The nurse should teach the patient and family which information about rivastigmine? a. That hepatotoxicity may occur b. That the initial dose is 6 mg t.i.d. c. That GI distress is a common side effect d. That weight gain may be a side effect - ✔✔-c. That GI distress is a common side effect 5.Which is a nursing intervention for a patient taking carbidopa-levodopa for parkinsonism? a. Encourage the patient to adhere to a high-protein diet. b. Inform the patient that perspiration may be dark and stain clothing. c. Advise the patient that glucose levels should be checked with urine testing. d. Warn the patient that it may take 4 to 5 days before symptoms are controlled. - ✔✔-b. Inform the patient that perspiration may be dark and stain clothing. What would the nurse teach a patient who is taking anticholinergic therapy for parkinsonism? (Select all that apply.) a. Avoid alcohol, cigarettes, and caffeine. b. Relieve dry mouth with hard candy or ice chips. c. Use sunglasses to reduce photophobia. d. Urinate 2 hours after taking the drug. e. Receive routine eye examinations. - ✔✔-a. Avoid alcohol, cigarettes, and caffeine. A patient is taking rivastigmine (Exelon) to improve cognitive function. What should the nurse teach the patient/family member to do? (Select all that apply.) a. Rise slowly to avoid dizziness. b. Remove obstacles from pathways to avoid injury. c. Closely follow the drug dosing schedule. d. Have frequent checks for hypertension. e. Receive regular liver function tests. - ✔✔-a. Rise slowly to avoid dizziness. b. Remove obstacles from pathways to avoid injury. c. Closely follow the drug dosing schedule. Your client has a fracture of the radius. There is swelling at the injury site and the client complains of pain in the area. Which stage of bone healing do these signs and symptoms represent? a. Cellular proliferation b. Inflammatory c. Ossification d. Callus formation - ✔✔-b. Inflammatory During the inflammatory phase, bleeding occurs at the area of injury and results in a hematoma. Why plus I was rushed to the area of injury to begin to debride the dead cells. The patient will experience pain during this phase. Cellular proliferation occurs after approximately 5 days, when the interrupted blood supply is recreated and fibrin strands begin to form. The callus formation stage takes about 3 to 4 weeks, while the ossification stage may take as long as 3 to 4 months. Remodeling of the bone may take months to years. Who was the English Quaker who advocated humane care and built an asylum to reflect a household? a. Florence Nightingale b. William Tukes c. Sigmund Freud d. Benjamin Rush - ✔✔-b. William Tukes Changes in the delivery of mental health care that resulted from the development of electroconvulsive therapy and psychotherapeutic drugs brought about which phenomenon in the 20th century? a. Behavioral therapy b. Personality disorganization c. Deinstitutionalization d. Brain surgery - ✔✔-c. Deinstitutionalization What is the best description of personality? a. The level of mental health that a person attains in life b. The relatively consistent set of attitudes and behaviors particular to an individual c. The result of a positive self-concept and acceptable behavior d. The ability to manage stress - ✔✔-b. The relatively consistent set of attitudes and behaviors particular to an individual The nurse is reviewing the assessment finding for a patient hospitalized with a stress disorder. What findings support the diagnoses? a. A vague feeling of depression b. An assumed role to protect the ego c. A main reason for all mental illnesses d. A response to any demand made upon the individual - ✔✔-d. A response to any demand made upon the individual The nurse is caring for a patient who is currently voicing feelings of anxiety. The nurse correctly recognizes what as the best description of the feelings that the patient is experiencing? a. A vague feeling of apprehension b. Feelings of paranoia c. Concerns about the impressions others have for her d. Emotional stability - ✔✔-a. A vague feeling of apprehension An assembly line manager in a factory was told that he would be laid off if his line did not meet the hourly quote. He promptly went to his workers and threatened to fire anyone who was found taking even 1 minute extra on a break. What is the manager displaying? a. Denial b. Regression c. Displacement d. Identification - ✔✔-c. Displacement Punishment and abandonment were how mentally ill people were treated in medieval times. These practices continued until the 17th and 18th centuries. Which care practice that is still being used today did Dr. Phillipe Pinel of France advocate? a. Electroshock therapy for melancholy b. Humane care with record keeping of behaviors c. Psychoanalysis d. Home care in the community - ✔✔-b. Humane care with record keeping of behaviors The student nurse is working on a presentation regarding OBRA. What was the result of this landmark legislation? a. Deinstitutionalization b. Approved surgical treatment for schizophrenia c. Prohibition of electroshock therapy d. Increased construction of state facilities for residential mental health care - ✔✔-a. Deinstitutionalization A 52-year old patient experienced cardiac arrest from a myocardial infarction. During his acute care stay in the hospital, the patient flirts with all female nurses. When he is asked to stop, he withdraws and later complains of chest heaviness. What is a possible explanation for the patient's behavior? a. Boredom from restricted activity b. Lack of motivation to recover c. Frustration from illness d. Threatened self-concept - ✔✔-d. Threatened self-concept A 14-year-old tells the school nurse that she is self-conscious about her recent breast development. She reports that the boys in her class are teasing her. What is the first step for the nurse to take? a. Call her parents b. Have her describe what happened c. Ask who her friends are d. Provide her with a pamphlet outlining the changes associated with puberty - ✔✔-b. Have her describe what happened Your patient with heart failure has been responding well to treatments that include medications such as ACE inhibitors and a loop diuretic. Today, the client is complaining about leg weakness and is refusing to ambulate. What is most likely occurring with this client? a. Hyperkalemia b. Hyponatremia c. Hypokalemia d. Hypernatremia - ✔✔-c. Hypokalemia Hypokalemia, or low potassium, often occurs as the result of treatments with loop diuretics like furosemide (Lasix). The signs and symptoms of hypokalemia include muscular weakness, pain and cramping, as well as serious cardiac dysrhythmias. Clients taking loop diuretics should be closely monitored for hypokalemia and also given potassium supplementation when indicated. Which of the following assistive techniques should the be used to transfer a patient who can bear weight from the bed to the chair? a. mechanical lift b. slide transfer c. pivot transfer d. assisted transfer - ✔✔-c. pivot transfer Your client is to have an NG tube inserted. To mark the tube prior to insertion, you should: a. place the tip of the tube at the corner of the patient's eye and extend the tip to the earlobe, and then to the tip of the xiphoid process. b. place the tip of the tube at the corner of the mouth and extend the tip to the top of the patient's ear, and then to the umbilicus. c. place the tip of the tube at the patient's nostril and extend the tip of the earlobe, and then to the tip of the xiphoid process. d. place the tip of the tube at the patient's nostril , extend it to the tip of the earlobe, and then to the base of the ribcage. - ✔✔-c. place the tip of the tube at the patient's nostril and extend the tip of the earlobe, and then to the tip of the xiphoid process. A patient with a history of alcohol abuse is arrested for driving under the influence. His wife bails him out of jail for the third time. His wife's response is an example of: a. attachement disorder b. reactivity c. codependency d. addiction - ✔✔-c. codependency codependency is a type of dysfunction in which one individual supports the addiction, substance abuse, immaturity, or other poor behavior of another in a relationship. Successful communication includes which of the following components? - ✔✔-Appropriateness, efficiency, flexibility, feedback According to Elizabeth Kubler-Ross, all of the following are considered stages of grief except: - ✔✔- Resentment Elizabeth Kubler-Ross, a psychiatrist, proposed a model that describes 5 stages commonly seen in those experiencing grief. These stages, which can occur in any order, include: denial, anger, bargaining, depression, and acceptance. The acronym "DABDA: can be used to help recall the 5 stages of grief. The purpose of inserting a chest tube is to: - ✔✔-Restore negatie pressure int he intrapleural space. Insertion of a chest tube is an invasive procedure designed to restore negative pressure in the intrapleural space. When the normally negative pressure of the intrapleural space is disrupted, it causes the lung to collapse and a patient to develop respiratory symptoms. Therefore, the tube is placed to restore negative pressure until the underlying condition can heal. Conditions that commonly necessitate a chest tube include a pneumothorax, blunt chest trauma, empyema, or hemothorax A 70-year-old obese males admitted to the cardiac unit with new onset of atrial fibrillation. While in the hospital, the night shift nurse notes that the patient is snoring loudly, then waking abruptly. In the early morning , he reports being excessively tired during the day. The nurse is suspicious for which of the following? - ✔✔-Obstructive sleep apnea Obstructive sleep apnea is a disorder found most often in older obese males. It is the lack of air flow due to an obstruction of the pharynx during sleep. Patients with obstructive sleep apnea often snore loudly and awaken frequently throughout the night following episodes of apnea. They often report daytime tiredness, sore throat, and headaches. For severe cases of sleep apnea, a device called a continuous positive airway pressure (CPAP) machine may be utilized. An elevated bilirubin may be a sign of: - ✔✔-Liver disease Bilirubin is a yellowish substance found in bile. It is produced by the body when red blood cells are broken down by the liver. Low levels of bilirubin are not typically a concern. High levels of bilirubin, however, may be a sign of disease and require further evaluation. The diagnostic marker used in patients with CHF is called: - ✔✔-B-type natriuretic peptide B-type natriuretic peptide (BNP) is secreted from the ventricles or lower chambers of the heart in response to changes in pressure that occur when heart failure develops and worsens. The level of BNP in the blood increases and worsens. The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. An 80-year-old male presents to the emergency department with dyspnea and a history of COPD. The licensed practical nurse teaches him about which type of the following positions to relieve dyspnea? - ✔✔-Tripod Proper positioning can provide relief for patients with COPD. The tripod position, in which the patient sits or stands leaning forward with the arms supported, forces the diaphragm down and forward and stabilizes the chest while reducing the work of breathing. Purse-lipped breathing may also be encouraged to control dyspnea and shortness of breath. The organization responsible for promoting safer, higher quality care among hospital organizations in addition to evaluating and providing accreditation is known as: - ✔✔-The joint commission (TJC) The Joint Commission is a non-profit organization that works to promote safer, higher quality care in hospital organizations. The Joint Commission is also responsible for evaluating and designating organizations with accreditation. Finally, the Commission publishes annual patient safety goals in order to improve overall patient safety. You are assigned charge nurse responsibilities for the upcoming month. In creating the schedule, you assign a fellow nurse that you do not get along with every holiday shift, despite the requirements being one holiday per season. This action is a violation of which ethical principle? - ✔✔-Non-maleficence Non-maleficence is the ethical principle that refers to "doing no harm." It can refer to doing no harm to patients, or doing no harm to fellow health care workers as well. Within this principle, one should act with empathy and without malicious intent. Care for the patient with active TB involves wearing a: - ✔✔-Respirator mask To prevent droplet spread of TB, health care workers must DON an appropriately fitting respirator mask. Surgical masks do not provide an appropriate seal to prevent the transmission of droplets, and therefore are not recommended in the care of the patient with active TB. Hospitals and health care organizations often conduct fit testing for TB respirator masks to determine the appropriate size mask for each employee. A "multiparous" woman is considered to have had: - ✔✔-2 or more childbirths pasts 20 weeks gestation. The root "para" is used to describe births past 20 weeks gestation. The prefix "multi" is used to describe many. Therefore, "multiparous" is the term used in obstetrics to refer to a woman who has had more than 2 births past 20 weeks gestation. The type of injection technique used to prevent staining and damage to the skin and subcutaneous tissue is known as: - ✔✔-Z-track The Z-track technique is a type of injection used to prevent staining and damage to the skin and subcutaneous tissue. It involves displacing the skin lateral to the injection site prior to injecting the medication. The common injection sites for this technique is the upper outer region of the gluteal. Cancer occurs when: - ✔✔-A cell's genetic mutations are defective and cannot induce cell death. Cancer occurs when a cell's genetic mutations are defective and therefore cannot induce cell death, also known as apoptosis. In the absence of apoptosis, cell growth becomes uncontrolled and invades various systems of the body, leading to various levels of dysfunction. Uncontrolled cell growth masses are also known as tumors. A nurse has performed a non stress test on a pregnant client and is reviewing the fetal monitoring strip. The nurse interprets the test as reactive and understands that this indicates which of the following? a. the need for further evaluation b. abnormal findings c. that the findings on the monitor were difficult to interpret d. normal findings - ✔✔-d. normal findings A reactive non stress test is a normal test. To be considered reactive, the baseline fetal heart rate must be within normal range (120-160 BPM) with good long term viability. Your client is in active labor at 41 weeks. The membranes rupture and you note that the fluid is thick and green in color. This is indicative of: a. blood b. infected amniotic fluid c. normal amniotic fluid d. meconium - ✔✔-d. meconium Amniotic fluid that is stained a greenish color and is thickened contains meconium, the newborn's first stool. This is a warning sign of potential fetal distress. The physician should be notified, and the newborn may require tracheal suctioning immediately following delivery. Asepsis is a term that refers to which of the following? a. clean b. dirty c. sterile d. infectious - ✔✔-c. sterile Assessment of clients with suicidal ideation should include: a. asking them whether they have a specific plan b. administering an antidepressant medication c. referring the client to a psychiatrist d. suggesting the client join a support group - ✔✔-a. asking them whether they have a specific plan Asking whether the patient has a specific plan in an assessment question. The other answers are interventions. Your client is receiving a continuous gastric tube feeding. The rate of the tube feeding is 75 mL per hour. You aspirate 45 mL of gastric contents. What should you do? a. discard the residual and discontinue the tube feeding b. continue the feeding and discard all of the residual c. return the measured residual and continue feeding d. return the measured residual and discontinue the feeding - ✔✔-d. return the measured residual and discontinue the feeding You should return the residual gastric contents back into the tube because it is less than 150 mL. Residual contents over 150 mL are not returned. You should also discontinue the tube feeding because the residual is more than 50% of the hourly rate. Half of 75 mLs is 34,5 mLs, and you have aspirated 45 mLs. You are caring for a child who has a temperature of 104 degrees. The child suddenly begins to rhythmically convulse. What is the first thing you should do? a. gently restrain the child's movement b. ensure the child's safety c. call the doctor d. administer an antipyretic medication as ordered - ✔✔-b. ensure the child's safety Seizures place clients, both children and adults, at risk of injuries, some of which can be life threatening. The first priority is safety. Later, when the child is out of danger, you should call the doctor and administer antipyretic medications as ordered. Client movement should be protected but not restrained during seizures or convulsions. Your patient's abdominal wound dehisces, and bowel can be seen protruding through the opened incision. Nursing interventions include: a. assessment of the patient's vital signs every hour b. positioning the patient in bed with the knees bent and the head of the bed no higher than 20 degrees to prevent an increase in intraabdominal pressure c. covering the wound with gauze soaked in betadine d. gently reducing the exposed viscera - ✔✔-b. positioning the patient in bed with the knees bent and the head of the bed no higher than 20 degrees to prevent an increase in intraabdominal pressure Positioning the patient appropriately will decrease abdominal pressure. Cover the wound with gauze or towels soaked in sterile saline. Do not attempt to replace any exposed organs. Assess vital signs every 15 minutes to watch for signs of shock. A set code of ethics for LPNs has been published by: a. American Medical Association b. American Nurses Association c. National Federation of LPNs d. National Association for Practical Nurse Education and Service - ✔✔-d. National Association for Practical Nurse Education and Service Within the code are principles that serve as a guide for LPNs when providing care to patients. NAPNEs also publishes a journal called the "Journal of Practical Nursing" You are caring for a child with epiglottitis. What equipment is most important to have at the bedside? a. chest tube and drainage system b. cricothyrotomy kit c. oxygen saturation minitor d. blood pressure monitor - ✔✔-b. cricothyrotomy kit airway management is most important. Patients may deteriorate quickly, and airway equipment, including equipment needed for cricothyrotomy, should be present at the patient's bedside. You would not need to insert a chest tube in a patient with epiglottitis. Prior to delegating a task, the nurse should first: a. be certain the delegates can legally carry out the task b. attempt to complete the task on his or her own c. be certain the task can be delegated d. call the physician for an order to permit delegation - ✔✔-c. be certain the task can be delegated Tom is the licensed practical practical nurse caring for a busy group of 12 patients on a medical/surgical unit. Within his patient assignment , there are eight patients with DM who need to have their blood glucose checked prior to dinner. In a pinch for time, Tom only performs blood glucose checks on 6 of the eight patients. This is an example of: a. Beneficence b. Malpractice c. negligence d. prioritization - ✔✔-c. negligence A 21-year-old woman comes into the emergency room, stating that she sustained injuries in a fall. She has a black eye and two fractured ribs. She has two children at home and is pregnant with her third child. She has no insurance and states she is unemployed. Her boyfriend is not accompany her to the emergency room. You suspect her injuries resulting from abuse. You ask the patient if she has been abused and she denies it. What is your best course of action? a. Do nothing it's none of your business b. Document your suspicions but do nothing c. Report the suspected abuse d. Tell the physician that you suspect the patient has been abused - ✔✔-c. Report the suspected abuse The nurse is caring for a patient with an infected surgical wound with wet to dry dressings. A wet to dry dressing involves: - ✔✔-Applying gauze soaked in Saline solution to a wound, then covering it with a dry gauze dressing. Hey wet to dry dressing is often ordered for a patient with an infected wound, in order to debrief any necrotic tissue. This type of dressing involves application of a gauze soaked in saline into or on top of the wound, then covering the wet gauze with a dry gauze. As drying occurs, the necrotic tissue is absorbed into the gauze. The dressing is changed when the gauze becomes dry. You are caring for an 8 month old infant. Which of the following is most appropriate to ensure your patient's safety? a. ensure that the patient's call bell is within reach b. provide 1:1 nursing care c. Inform the parents that they are not allowed to leave the patient's room at any time d. ensure that the bars on the crib are raised to their highest level whenever the patient is unattended - ✔✔-d. ensure that the bars on the crib are raised to their highest level whenever the patient is unattended Ensuring that the bars on the crib are raised to their highest level will prevent the patient from falling. The infant will be unable to use a call bell. Providing 1:1 nursing care is not always feasible. Parents will need to leave the room for brief periods and should be reminded to ensure the bars on the crib are at the highest level. They should also be reminded to inform nursing staff when the patient is unattended All of the following are teaching points for the patient with a colostomy except: a. change the colostomy bag while in front of a mirror b. change your pouch daily c. wash the stoma and skin around the stoma d. apply skin barrier prep or wipes before applying a new pouch - ✔✔-b. change your pouch daily pouches should be changed every 5 to 7 days or as needed in between A nurse falsifying the narcotics record within a patient's medication administration record is an example of: a. felony b. unintentional tort c. negligence d. misdemeanor - ✔✔-a. felony You are a home health care nurse who is conducting an environment safety survey of the client's home. Which safety risk must be immediately addressed and corrected? a. the unknown date of battery changes in the smoke alarms b. absence of food in the refrigerator c. not enough lighting in the house - ✔✔-a. the unknown date of battery changes in the smoke alarms Batteries in smoke alarms should be changed at least every 6 months. When the date of the last change is not known, the nurse should not assume that the batteries are still good. The nurse. therefore, must change the batteries and note the battery change date in order to protect the home client from fire hazards. The most common sexually transmitted disease in the United States is: a. HIV b. Gonorrhea c. Chlamydia - ✔✔-c. Chlamydia The most common STD in the United States is chlamydia. Around 5 million people in the US contract the disease annually. In addition, it is estimated that around one billion health care dollars are spent each year on the diagnosis and treatment of chlamydia. Providing education to men and women about symptoms, transmissions, and prevention is essential. The indirect Coombs test is performed on pregnant woman in order to: - ✔✔-Determine if the mother has antibodies to the fetus's blood. An indirect Coombs test determines whether there are antibodies to the Rh factor in the mother's blood. A normal, or negative, result means that the mothers not developed antibodies against the fetus's blood. A negative Coombs test indicates that the fetus is not presently in danger from problems relating to Rh incompatibility. An abnormal, or positive, result means that the mother had developed antibodies to the fetal RBCs and is sensitized. This result requires the injection of a medication called Rho(D) immune globulin. The LPN is reviewing lab results for a patient on her unit. She notes a hemoglobin level of 5.9 gm/dL. The most appropriate initial response is: - ✔✔-Notifying the physician immediately A hemoglobin level of 5.9 gm/dL is considered critically low. The most appropriate initial response is to notify the physician. Pending the physician's recommendation, repeat tests and diagnostics exams may then occur. In general, a hemoglobin level above 12 gm/dL would be considered normal for an adult. What is the rationale for not using the gluteal muscle for injections in children until they are approximately 2 years of age? a. this area is too painful for children to receive injections in b. a painful muscle from an injection into this site may cause the child to stop walking and regress in behavior c. injecting into this area may cause bruising which may be mistaken for child abuse d. it takes time for the gluteal muscles in children to develop after they have begun to walk - ✔✔-d. it takes time for the gluteal muscles in children to develop after they have begun to walk In children, you do not inject into the gluteal muscle until they have reached approximately the age of 2 and have been walking for a time sufficient to develop the muscle Your client has legally appointed health care surrogate who decides to withhold all food and fluids from the client. The continuation or discontinuation of food and fluids was not documented in the client's advance directives. You feel that withholding food and fluids is cruel and inhumane. What is your best action? a. withhold the food and fluids even if you believe it is cruel, inhumane, and illegal b. report this ethical dilemma to the client's family and doctor so that it can be resolved c. feed the client and provide fluids to ensure humane care even when you feel it violates ethical practice d. request an ethical conflict resolution with the ethics committee or the nursing supervisor - ✔✔-d. request an ethical conflict resolution with the ethics committee or the nursing supervisor Many healthcare facilities have multidisciplinary ethics committee that convene to resolve ethical dilemmas and conflicts. Some of the commonly occurring ethical dilemmas that impact clients revolve around euthanasia, physician assisted suicide, the continued administration of pain medications to relieve pain even when it hastens death, advance directives, and withholding food and fluids You are educating a newly diagnosed 55 year old male with type 2 diabetes. Which of the following will you tell your patient is most effective in attaining normal or near normal blood glucose levels? a. quitting smoking b. controlling hypertension c. weight loss d. exercising - ✔✔-c. weight loss Weight loss has been shown to help lower and maintain blood glucose levels. In addition to improving general health, all these measure will decrease the risk of developing cardiovascular disease Your male patient has had a TURP (transurethral resection of the prostate). He has a 3 way catheter, and CBI (continuous bladder irrigation) is ongoing. He suddenly complains of lower abdominal discomfort. He is diaphoretic and tachycardia. You notice that his catheter is bypassing. What should you do first? a. increase the flow of the irrigation b. stop the irrigation immediately c. call the physician d. attempt to manually irrigate the catheter - ✔✔-b. stop the irrigation immediately You should turn the bladder irrigation immediately to prevent further distention of the bladder. It is likely that the catheter had become blocked, resulting in the patient's symptoms. You may manually irrigate the catheter if it is within your scope of practice. The physician should be notified, but the most important first step is to stop the irrigation A 36 year old woman has just discovered she is pregnant. The pregnancy is unplanned and she feels ambivalent about it. She expresses to you that she feels guilty about not feeling more excited about the baby. What would be your best response? - ✔✔-"It's normal to feel ambivalent at the beginning of a pregnancy" The license practical nurse is reviewing laboratory data for a patient with COPD. She notes that the glucose levels are abnormally elevated, but the patient has no history of diabetes. Which medication is most likely to be responsible for elevated gluclose levels? - ✔✔-Glucocorticoids Glucocorticoids are a type of steroid that maybe administered for patients with a history of asthma or breathing problems, among other indications. They are administered to reduce inflammation in the body. A well known side effect of steroids is hyperglycemia, which may be treated with short acting insulin if necessary. A nurse is monitoring a postpartum client in the fourth stage of labor. Which of the following findings, If noted by the nurse, would indicate a complication related to a laceration of the birth canal? - ✔✔-The saturation of more than one peripad per hour In the first 24 hours after birth, the uterus will feel like a firmly contracted ball, roughly the size of a large grape fruit. One can easily locate the uterus at the level of the umbilicus. Saturation of more than one peripad per hour is considered excessive in the early postpartum period. You need to perform an admission on a patient who does not speak English. What is the best course of action? - ✔✔-Locate a translator and ask them to translate for you while you perform your admission assessment. A patient is receiving treatment with a continuous heparin infusion for a DVT. They have a PTT level checked, which comes back Supra-therapeutic. Based on the results the nurse will: - ✔✔-Stop the infusion Patients receiving treatment with heparin infusion will have blood levels monitored using partial thromboplastin time, or PTT. The PTT level will determine whether the rate of infusion will need to be changed. For a patient who has a Supra-therapeutic PTT level, the infusion will be stopped and then restarted at a lower rate. Failure to respond to higher than normal bleeding times can lead to exessive bleeding and shock. The doctor has ordered 1000 cc of 0.9% sodium chloride over 8 hours. How many drops per minute would you administer if you are using an IV set that delivers 15 drops per cc? - ✔✔-31 gets/min The answer is calculated as follows: 1000/8 = 125 cc per hour; 125/4 = 31.25 cc, which is rounded to 31 gets per minute. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during contraction? - ✔✔-Variable declarations Variable declarations occur if the umbilical cord is compressed, reducing blood flow between the placenta and the fetus. Early declarations result from pressure on the fetal head during a contraction. Late declarations are an ominous pattern in labor because they suggest uteroplacental insufficiency during a contraction. Your patient has just returned to her room following a cystoscopy. What should you monitor the patient for? - ✔✔-Bleeding Cystoscopy, in which the bladder and urethra are viewed with a scope, has the potential to cause bleeding. Monitor the color of the patient's urine to assess for bleeding. Which client is at greatest risk for rejection of a bone marrow transplant? a. The one who received a syngeneic bone marrow transplant b. The one who received an allogeneic bone marrow transplant c. The one who received a heterogenous bone marrow transplant d. The one who received an autologous bone marrow transplant - ✔✔-b. The one who received an allogeneic bone marrow transplant There are 3 types of bone marrow transplants. Transplants can be allogeneic, syngeneic, or autologous. Allogeneic bone marrow transplants may or may not be an HLA match, and the donor can be related or unrelated to the recipient. This type of transplant is associated with the greatest risk of rejection. Syngeneic transplants come from an identical twin, and autologous transplants are from the patient himself. They are therefore less risky than allogeneic transplants. Of the following positions, which is most appropriate for pelvic examination? a. Prone b. Trendelenburg c. Lithotomy d. Semi-Fowlers - ✔✔-c. Lithotomy The lithotomy position is used during pelvic examinations, to provide adequate visualization of the internal female reproductive organs. Your patient has genital warts and has just learned that she is pregnant. She has been applying podofilox topically. She asks you whether it is safe to continue this treatment. What is the best response? - ✔✔- "This medication is not safe to use during pregnancy." Podofilox may induce abortion. It is not available in an oral form. Cryotherapy, laser surgery or other treatments may be used to treat genital warts. Your client has an abdominal incision. Which of the following beverages will best facilitate wound healing? a. Milk b. Diet soda c. Apple juice d. Orange juice - ✔✔-d. Orange juice Orange juice contains high amounts of vitamin C. Vitamin C helps in the formation of collagen, which is important for wound healing. There has been a large fire in your facility, causing damage from water and smoke. You have been notified to prepare a list of all patients than can be safely discharged home. Which of the following patients could be safely discharged? a. a 58 year old male palliative care patient with lung cancer or continuous morphine for pain control and oxygen by mask at 8 liters per minute b. a 2 year old female with epiglottis and inspiratory stridor c. a 25 year old female patient receiving IV antibiotics for pyelonephritis (last dose due in 2 hours) - ✔✔- c. a 25 year old female patient receiving IV antibiotics for pyelonephritis (last dose due in 2 hours) The patient with pyelonephritis could be discharged home on oral antibiotics and counseled to return if her condition deteriorates. The other patients are unstable or require continuous nursing care Menopausal symptoms include all of the following except: a. depression b. headache c. narcolepsy d. hot flashes - ✔✔-c. narcolepsy Menopause is the cessation of menstruation. Generally speaking, the ovaries no longer respond to stimulation form the pituitary gland, resulting in failure to ovulate. Hormonal changes from menopause can trigger a number of unpleasant symptoms. The most common menopausal symptoms include headache, insomnia, fatigue, depression, and hot flashes. While hormonal replacement therapy was at one time considered standard care, there has been controversy regarding its use over the last several years due to studies revealing a potential association with cancer. The LPN is working as a home health nurse. She is visiting a new patient in their home and conducts a home safety assessment. Her assessment should include all of the following except: a. location of medications b. adequacy of lighting c. food preferences d. placement of furniture - ✔✔-c. food preferences A home safety assessment should be conducted by the home health nurse and include a number of areas for review. It is important to assess adequacy of lighting and inspect the areas in which the patient walks or moves around. Within this area, also assess the location and presence of furniture or large items that may provide barriers to a patient's mobility. The nurse should also obtain an understanding of the location of medications and cleaning supplies, to be certain they are within easy reach of the patient. Food preparation and storage practices should be assessed to ensure there is no risk of poisoning, but food preferences would not be important in conducting the home safety assessment. You are providing chest compressions. Another colleague is providing ventilations with a bag valve mask. When should you and your colleagues switch positions? a. after 2 minutes of CPR, or before if you are becoming fatigued b. after 3 minutes of CPR c. after 10 minutes of CPR d. never you should continue with the roles you are in - ✔✔-a. after 2 minutes of CPR, or before if you are becoming fatigued You are caring for a patient who has been diagnosed with AIDS following treatment for PCP (pneumocystis pneumonia). The patient's CD4 count is 300. You know that the guidelines for antiretroviral therapy state that patients should be started on therapy when the CD4 count: a. is > 500 cells/mm3 b. is ≥ 400 ≤ 500 cells/mm3 c. is < 500 cells/mm3 d. is < 350 cells/mm3 - ✔✔-d. is < 350 cells/mm3 Antiretroviral therapy should be initiated in all patients with a history of an AIDS-defining illness or with a CD4 count < 350 cells/mm3. The presence of an AIDS-defininf illness, such as PCP, also indicates that antiretroviral therapy should be started. Your patient is allergic to peanuts. You are teaching him to use an Epiphyseal pen. Choose the correct information regarding Epi pens: a. 3 doses of adrenalin should be given one after the other while the patient is en route to the hospital b. side effects of epinephrine administration are rare c. Epi pens are not curative-patients must proceed to the nearest emergency room after injecting themselves using an Epiphyseal pen d. slower absorption is achieved via the IM route - ✔✔-c. Epi pens are not curative-patients must proceed to the nearest emergency room after injecting themselves using an Epiphyseal pen Use of an Epi pen buys time for the patient to get to the emergency room. Other treatments are often needed in conjunction with epinephrine/adrenaline. Symptoms may return when the epinephrine wears off. Rapid absorption is achieved through the IM route. Patients should auto inject one dose before calling the ambulance. Sid effects are common and may include headache, dizziness, tachycardia, and anxiety. You are caring for a patient admitted with dehydration. Blood work has been drawn as ordered. You have started an IV of normal saline, which is infusing at 150 mL/hour. You are performing your admission assessment when you receive a call from the lab that your patient's BUN level is 102 mg/dL. What is your first action? a. decrease the rate of IV infusion b. do nothing-this level is normal for a patient who is dehydrated c. notify the physician-this is critical level d. increase the rate of the IV infusion - ✔✔-c. notify the physician-this is critical level BUN (blood urea nitrogen) is a reflection of renal function. Normal values are 7 to 20 mg/dL. The patient's BUN is at critical level-notify the physician. You should not change the IV rate without a physician's order. A patient undergoes laboratory testing with a basic metabolic panel. The nurse in the outpatient clinic notes a potassium level of 2.8 mEq/L. The nurse proceeds with the following teaching: a. encourage intake of foods such as apples, cabbage and corn b. encourage intake of foods such as grapes, eggplant, and peaches c. encourage intake of foods such as bananas, leafy green vegetables, and beans d. encourage intake of foods of foods such as cauliflower, applesauce, and blackberries - ✔✔-c. encourage intake of foods such as bananas, leafy green vegetables, and beans A normal potassium level is between 3,5 and 5 mEq/L. The patient's potassium level is low, and therefore the nurse should proceed with encouraging intake of foods high in potassium. Such foods include bananas, leafy green vegetables, and beans. The other foods mentioned are all low in potassium and would be more useful for a person with chronic kidney disease who may have high potassium levels. Working on another's behalf to represent his concerns as a moral agent is referred to as which of the following? a. beneficence b. nursing practice c. advocacy d. ethical practice - ✔✔-c. advocacy A physician orders a continuous heparin infusion for a patient with a blood clot. The order reads: "administer heparin 16 units/hour/ kg IV infusion." The patient weighs 55 kg and the heparin bag comes in a 500 mL bag with 25,000 units of medication. The infusion pump should be set at: a. 16.1 mL/hr b. 17.6 mL/hr c. 24.3 mL/hr d. 10.8 mL/hr - ✔✔-b. 17.6 mL/hr To complete the dosage calculation, one would proceed with the following calculations: 16 units x 55 kg = 880 units/hour (25,000 units)/(500 mL) = (880 units/hour)/(x mL/hr) (25,000 units) x (x mL/hr) = 440,00 x mL/hr = 440,000/25,000 units x = 17.6 mL/hr Concepts formed as a result of culture, family, friends, education, and work are known as: a. ideas b. values c. religion d. principles - ✔✔-b. values Within each state or jurisdiction, the board of nursing defines: - ✔✔-Scope of practice The physician informs a spouse that his wife is terminally ill. The spouse punches the doctor. This is an example of: a. Denial b. Acting out c. Sublimation d. Projection - ✔✔-b. Acting out Acting out involves performing an extreme behavior in order to express feelings or thoughts the person feels unable to express otherwise. Denial is complete rejection of a feeling or thought. Sublimation is directing one's feelings into a socially productive activity. Projection is believing that someone else has the same feeling or thought as you. Immediately after an amniotomy has been performed, the nurse should first assess which of the following? a. the fetal heart rate pattern b. cervical dilation c. bladder distension d. the maternal blood pressure - ✔✔-a. the fetal heart rate pattern The FHR is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse. Bladder distention or maternal blood pressure would not be the first thing to check after the amniotomy Your patient has just had a PICC (peripherally inserted central catheter) inserted. Which of the following statements indicates that your patient requires further teaching? a. "I will not lift more than 10 pounds with my affected arm." b. "I will inspect my catheter site daily for signs of redness, leaking, or swelling." c. "I will ensure that no one takes a blood pressure reading in my affected arm." d. "If my catheter breaks, I will apply tape and call my physician/nurse within 24 hours." - ✔✔-d. "If my catheter breaks, I will apply tape and call my physician/nurse within 24 hours." The patient should be counseled that should the catheter break, whether bleeding does or does not occur, they should apply sufficient pressure at the site with sterile gauze so that it is tightly and well covered and immediately report this to the physician. Maintain pressure on the site at all times. All other answers are correct. What preparation is required on the part of the female patient prior to having a Pap test (Pap smear)? a. fleet enema b. shaving c. no preparation is necessary d. douching - ✔✔-c. no preparation is necessary No preparation is needed for a Pap smear. Women may be advised to refrain from douching or using vaginal creams or suppositories within 24 hours of test. Refraining from sexual intercourse is unnecessary. A rectal exam is sometimes performed along with the Pap smear test, but there is no need to prepare the bowel Your patient has diarrhea from an infectious cause and has been prescribed antibiotics. He asks you what he should be eating until the diarrhea had resolved. Choose the best response. a. "caffeine will decrease bouts of diarrhea due to its dehydrating effects" b. "eating spicy foods will kill the bacteria causing diarrhea" c. "eat bland foods such as toast, apples, rice, and bananas" d. "eating a high fiber diet will decrease diarrhea" - ✔✔-c. "eat bland foods such as toast, apples, rice, and bananas" What are the phases of shock in correct sequential order? a. the initial stage, the compensatory stage, the progressive stage, and the final or refractory stage b. the initial stage, the progressive stage, the compensatory stage, and the final or refractory stage c. the initial stage, the refractory stage, the compensatory stage, and the progressive stage d. the primary stage, the compensatory stage, the progressive stage, and the final or refractory stage - ✔✔-a. the initial stage, the compensatory stage, the progressive stage, and the final or refractory stage The initial stage is characterized by hypoxia and increases of lactic acid; the compensatory phase is marked with hyperventilation and other compensatory mechanisms; the progressive phase is accompanied by metabolic acidosis and the failure of compensatory mechanisms; and the final, or refractory, phase has a very poor prognosis; death is imminent A nurse is assessing a newborn infant to a mother who is addicted to drugs. Which of the following assessment findings would the nurse expect to note during the assessment of this infant? a. sleepiness b. incessant crying c. lethargy d. cuddling when held - ✔✔-b. incessant crying A new born infant who is born to a drug addicted mother is irritable. The infant is easily overloaded by sensory stimulation. The infant may be difficult to console. The infant would hyperextend and posture rather than cuddle when held. Which of the following types of tracheostomy tubes allows the patient to speak when it is capped? a. fenestrated tube b. double lumen tube c. cuffed tube d. single lumen tube - ✔✔-a. fenestrated tube A tracheostomy is a direct opening into the trachea to maintain potency of the airway. A tube is then inserted into the opening; there are different types of tubes. The fenestrated tube is a type that has an opening along the posterior aspect of the outer cannula. When it is capped, the patient is able to breathe through their upper airway and speak as well. It is important to note that the cuff must always be deflated prior to capping a fenestrated tube. Your pregnant client has a high level of alpha fetoprotein. What does this high level suggest? a) congenital nephrosis b) placenta prebia c) uterine atony d) all of the above - ✔✔-congenital nephrosis Alpha fetoprotein levels (AFP) are analyzed at 15 to 20 weeks gestation. Elevated levels of AFP are associated with chromosomal abnormalities such as open neural tube defects, open abdominal defects, and congenital nephrosis. Decreased levels are associated with down syndrome and other chromosomal anomalities. Further testing is indicated when the AFP level is abnormal. The most common complication of hemodialysis is: a) hypertension b) hypotension c) nausea and vomiting d) general weakness - ✔✔-Hypotension Hypotension occurs most frequently, affecting 20-30% of patients at some point. It may be caused by removing too much weight (i.e. due to inaccurate pre-dialysis weight), heart disease, septicemia, or taking blood pressure medications prior to dialysis. You are working in the ED when you are notified that the ambulance is bringing in a woman who has taken an overdose of Tylenol. You should anticipate administering which of the following drugs? a) Narcan b) N-acetylcysteine c) Epinephrine d) 1 L bolus to dilute the effects of Tylenol in the blood stream - ✔✔-N-acetylcysteine The antidote to acetomeniphen overdose is N-acetylcysteine (NAC). It is most effective when given within 8 hours of ingesting acetaminophen. NAC can prevent liver failure if given early enough. A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of what? a) placenta prebia b) abruptio placenta c) placental separation - ✔✔-Placental separation As the placenta separates, it settles into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. You are admitting a new patient onto the unit. The patient tells you that he is allergic to penicillin. In addition to the name of the medication, what is MOST IMPORTANT for the nurse to know about the patient's allergy? a) the type and severity of reaction experienced b) any other allergies to medications c)any history of treatment for this reaction - ✔✔-a) the type and severity of reaction experienced Understanding the type of reaction experienced is very important. For example, a patient might state that he is allergic to codeine because it causes an upset stomach. This is a side effect and not a true allergic reaction. On the other hand, a patient might experience an anaphylactic reaction to a medication. This is a severe reaction which could result in death. Insensible loss of water from the body occurs mainly in the: - ✔✔-Lungs and skin Sensible sources of water loss include sweat, urine and water lost from the intestines. Insensible sources of water loss include the lungs and skin. The LPN is caring for a patient who is unconscious. The LPN provides oral care to the unconscious patient: a) every four hours b) daily c)every two hours d) once a shift - ✔✔-Every two hours For the patient who is unconscious, mouth breathing is common. Therefore, in order to maintain the integrity of the oral cavity and mucous membranes, oral care should be given every two hours and as needed in between. A nurse is caring for a patient with meningitis and implements which transmission-based precautions for the client? a) standard precautions b) isolation precautions c) private room or cohort client d) no precautions are needed, meningitis is not a communicable disease - ✔✔-c) private room or cohort client Meningitis is transmitted by droplet infection. Precautions for this disease include private room or cohort client and use of a standard mask. When appropriate, the client must wear a mask when leaving the room, not the staff. Your patient, who is recovering from heart surgery, suddenly becomes unresponsive. You determine that the patient is apneic and pulseless and begin CPR, calling for help as you do so. The cardiac monitor shows a wide, regular and rapid rhythm. You know that this rhythm is probably: a) Ventricular fibrillation (V-Fib) b) Sinus bradycardia c) Normal rhythm the patient is recovering d) Ventricular tachycardia - ✔✔-d) Ventricular tachycardia Ventricular tachycardia appears as a wide, rapid and regular rhythm on the cardiac monitor or ECG. A recent history of angina, CHF or MI makes it more likely that the rhythm is ventricular tachycardia, rather than a more benign rhythm with aberrancy. A patient comes into the emergency room after being stung by a wasp. The patient is known to be allergic to wasps. You administer oxygen and epinephrine, obtain vital signs, initiate an IV and administer IV fluids. The patient is hypotensive. How should you position this patient? a) in the supine position laying flat in bed b) in the fowler's position making it easier for the patient to breathe c) in a lateral recovery positon in case the patient were to start feeling nauseous d) in the recumbent position with the legs elevated - ✔✔-d) in the recumbent position with the legs elevated Placing the patient in the recumbent position with the legs elevated above heart level will improve venous return and help increase blood pressure. Your patient has just expired as the result of pneumocystis jirovecci pneumonia, an opportunistic infection, secondary to the patient's known positive HIV status. As you are performing post mortem care, you should do which of the following? a) Do not necessarily use standard precautions because the client is dead and no longer infectious b) place the patient in a double shroud to prevent the spread of infection during transport c) care for the client in the same manner that you did while he was alive d) use protective eye wear to prevent respiratory droplet infection from pneumocystis jirovecii pneumonia spray - ✔✔-c) care for the client in the same manner that you did while he was alive Standard precautions are used on all clients, including those diagnosed with HIV, after they have expired. The virus remains infectious in all bodily fluids.