The nurse receives news of a local mass shooting. Stable clients need to be discharged to
make room for newly admitted clients. Which client would the
... [Show More] nurse identify as safe to
recommend for discharge?
1.
Client on chemotherapy who started antibiotics today for cellulitis of the leg
2.
Client with asthma exacerbation who has not required oxygen or a nebulizer in 12 hours
3.
Client with diabetes who has nausea, abdominal pain, and vomiting
4.
Client with ulcerative colitis and diarrhea who has developed fever and vomiting
Correct answer 2
2. Which tasks can the licensed practical nurse appropriately assign to unlicensed assistive
personnel? Select all that apply.
1.
Assist the nurse in ambulating a client 1 day post abdominal surgery
2.
Measure and empty drainage output into a bulb drain
3.
Monitor for redness and swelling at a client's IV insertion site
4.
Provide extra blankets at the client's request
5.
Take family members to the waiting room after a client goes into surgery
Correct answer 1,2,4,5
3. Unlicensed assistive personnel on the cardiac floor report to the nurse that, during the first
vital sign measurement on the shift, a client's blood pressure measured 198/102 mm Hg on the
automated blood pressure machine. What action should the nurse take first?
1.
Have unlicensed assistive personnel recheck the client's blood pressure
2.
Immediately notify the supervising registered nurse
3.
Obtain the client's prn labetalol from the medication dispensing machine
4.
Recheck the client's blood pressure with a manual cuff
Correct answer 4
4. The practical nurse and the charge nurse work together to assign a semi-private room to a
client with diabetes mellitus admitted for IV antibiotic therapy to treat leg cellulitis. Which of
the 4 room assignments is the best option for this client?
1.
Room 1: Client 1 day postoperative laparoscopic cholecystectomy who is awaiting
discharge
2.
Room 2: Client with dementia and urinary incontinence wearing an external urine
collection device
3.
Room 3: Client with history of splenectomy 15 years ago, now admitted for pulmonary
embolism
4.
Room 4: Client with lupus nephritis who is prescribed treatment with azathioprine
Correct answer 2
5. The nurse is caring for a client with moderate asthma exacerbation. Which of the following
assigned tasks are within the practical nurse's scope of practice? Select all that apply.
1.
Administering albuterol metered-dose inhaler and evaluating client response
2.
Checking oxygen saturation with the pulse oximeter
3.
Monitoring for shortness of breath and labored breathing
4.
Teaching client how to use a newly prescribed peak expiratory flow meter
5.
Writing the plan of care based on the client's peak flow results
Correct answer 1,2,3
6. The nurse receives report on 4 clients. Which client should the nurse see first?
1.
Client 1 day postoperative receiving patient-controlled analgesia with morphine who
reports itching and nausea
2.
Client receiving maintenance IV normal saline solution with labeled tubing indicating that
tubing was changed 48 hours ago
3.
Client with a pulmonary embolus receiving continuous IV heparin infusion and warfarin
who has an International Normalized Ratio of 1.9
4.
Client with a resistant bacterial infection receiving IV vancomycin who reports discomfort
at the peripheral IV site
Correct answer 4
7. A client with AIDS treated for intractable seizures is transferred from the intensive care unit to
the medical unit. There are 4 semiprivate room beds available. Which room assignment does
the nurse recognize as the best option for this client?
1.
Client with Clostridium difficile
2.
Client with community-acquired pneumonia
3.
Client with fever of unknown origin
4.
Client with upper gastrointestinal bleed
Correct answer 4
8. The nurse has just received report on 4 clients. Which reported information is the most
concerning?
1.
Client on a heparin drip with an activated partial thromboplastin time of 60 seconds
2.
Client reporting back pain 1 hour following coronary angiography
3.
Client with a head injury and a Glasgow Coma Scale score of 14
4.
Client with incisional pain rated 6/10 on day 2 post coronary artery bypass graft
Correct answer 2
9. Client call lights come on while the unlicensed assistive personnel (UAP) sits at a desk and
reads a magazine. When the nurse asks the UAP to answer the lights, the UAP says, "Those
aren't my clients." What is the best response by the nurse?
1.
"Would you mind answering the lights anyway?"
"I need you to answer the lights because we want to provide good client care." [Show Less]