RASMUSSEN LPN PN1 EXAM 3
1. The question got cut off but the answer is below:
-He took a culture of your wound to see if there are bacteria
... [Show More] present
-The doctor is making sure you do not have an infection present in your system
2. The nurse is changing the dressing on a clients wound. The nurse understands which of the following symptoms indicate a wound infection?
Redness over 1 cm wide on periwound skin and tenderness
3. The nurse is developing a teaching plan for a client who is going home with a tracheostomy tube. Which of the following is the MOST important part of the teaching plan?
The family of a client should know what to do in a case of emergency, i.e.: clogged tracheostomy tube and how to suction the client.
4. A 64-year-old male client comes to the provider’s office and complains of both legs hurting him when he walks a few blocks in his neighborhood. He states “When I sit down for a while, the pain eases off, but if I start walking a few blocks more, the pain comes back. The nurse recognizes this symptom may be related to peripheral vascular disease and is called what?
Intermittent claudication
5. A narrowing and hardening of the arteries is called:
Arteriosclerosis
6. A client has clusters of small vesicles over the thoracic region and describes severe pain and itching of the affected areas. Herpes zoster is diagnosed, and the client will be treated with which of these medications?
Acyclovir (Zorivax)
7. When administrating oxygen to clients with conditions such as emphysema, it is important for the nurse to remember which one of the following facts as most important
The drive to breathe may be dependent on low levels of oxygen in the blood
8. The nurse is preparing to instruct the client with pneumonia on managing the disease after discharge from the hospital. Which of the following is consistent with appropriate discharge planning for this client?
Take all medications until they are finished, as ordered by MD
9. Immediately after sustaining severe burn wounds, the nurse would anticipate the client’s initial nutritional needs would usually be met by which of these methods?
Total parenteral nutrition (TPN)
10. Which of the following measures should the nurse take when care for a client with TB in an acute care facility?
Double-bag and dispose of client secretions as infectious waste
11. When the nurse is collecting subjective data, while caring for a client with asthma, one of the most important history items to know is which of the following?
What stimulus triggers the asthma response?
12. The nurse is about to teach a client ideas to prevent coronary artery disease from resulting in angina. She knows it is best to recommend the client participate in which of the following health promotion ideals?
Walk 30 minutes per day three to four days per week
13. An 88 year old gentleman comes into the doctor’s office and tells the nurse “he thinks he is in heart failure. He has had left-sided heart failure before a couple years ago”. Choose the most common signs and symptoms of left-sided heart failure the nurse may anticipate to see in this client from the list below. (Select all that apply)
-Breath sounds have moist crackles
-Tachycardia and low blood pressure
-Pink, frothy sputum and shortness of breath
14. Client teaching in Raynaud’s disease should include which of the following?
Avoid temperature extremes, especially cold
15. The nurse is aware that course crackles, sonorous and sibilant wheezes, pleural friction rub, and stridor are examples of what type of breath sounds?
Adventitious
16. A 72 year old female client is about to be discharged home after being in the hospital for 3 days with bronchitis. She is weak and lives alone. She voices concern “over not having much support and would like to know what she can do to get better really soon and prevent this from happening again”? As the nurse, choose the nest intervention below to give her.
Avoid respiratory irritants, large crowds, and people who are coughing
17. A nurse is planning preventative care for a client who has pressure ulcers and is confined to bed. Which of the following is an appropriate nursing action?
Reposition the client every 1-2 hours
18. The nurse should consider which of the following as being normal occurrences in children with asthma? (select all that apply)
-Children should use their inhaled bronchodilators 15 to 20 minutes before exercising
-Asthma attacks are often associated with definite allergies
-Oral bronchodilators should be taken 30 to 60 min before exercising
19. Which of the following defense mechanisms are involved in the protection of the respiratory system? (select all that apply)
-Coughing is a respiratory defense mechanism used to keep the airway open
-Sneezing helps to expel foreign particles
-Mucous produced by goblet cells helps to trap foreign particles
-Surfactant reduces surface tension and helps to keep alveoli open
20. The nurse is about to measure her client’s venous ulcer on the left lower extremity. The nurse should be aware to always measure wounds in what measurement value?
Centimeter
21. A client with tonsillitis is having trouble swallowing her antibiotic medicine. The provider has ordered the following liquid antibiotic: Ampicillin 500mg every 6 hours po. The medication on hand is 125mg/ 5ml. How many milliliters will the client receive with each dose?
20ml
22. The provider orders a dressing for a client with a wound. The student nurse is aware that the purpose of applying dressings includes which of the following? (Select all that apply)
-To promote support for the wound
-To support healing by absorbing drainage
-To promoting a moist wound environment for epithelialization
23. A nurse is preparing to teach the client about management of varicose veins. Which of the following instructions are considered best advice? (Select all that apply)
-Do not fold down your stockings from the top, as it may cut off your circulation.
-Remove support hose daily, so you can wash and dry your legs
-Apply your support hose before you get out of bed in the morning
24. Which of the following lung structures is the primary site for gas exchange?
Alveoli
25. Which of the following types of exudate should the nurse know is not considered “normal” when completing her nursing wound assessment?
Purulent
26. The nurse is caring for a client experiencing a respiratory pattern characterized by an increased rate of respirations. The nurse notes this is in the client’s record as what type of respiration?
Tachypnea
27. A client who had a laryngectomy will be discharged soon. Which of the following approaches would BEST provide the nurse with necessary information about support and home care?
“Who do you have at home to help you once you are discharged?”
28. A nurse notes a small section of bowel protruding through the abdominal incision of a post-operative client. Which of the following actions should the nurse perform first?
Cover the bowel and incision with a moist sterile dressing
29. The nurse is performing a respiratory assessment on her client and hears an abnormal sound in the lower, posterior lobe of the right lung on inspiration that sounds like a fine snap and popping sound. She recognizes this adventitious breath sound to be which of the following?
Crackles
30. A client presents the urgent care clinic with a nosebleed (epistaxis). The nurse is aware that this condition could be minor in nature or could lead to hypovolemic shock if significant blood loss has occurred. Select the correct answer below that is a main goal of treatment for nosebleeds.
Stop the bleeding
31. Which of the following diseases is a major cause for coronary artery disease to develop?
Atherosclerosis
32. Which of the following medications would be administered to a client in the initial treatment of myocardial infarction?
Morphine sulfate and aspirin therapy
33. The nurse has received an order to have her client’s blood work drawn to monitor the client’s Coumadin therapy. The nurse should expect the lab to be drawn as which of the following?
PR/INR
34. Discharge teaching for the client recuperating from thrombophlebitis would include which of the following?
Evaluate affected leg when sitting
35. The most important nursing intervention for the nurse to remember in administrating Digoxin to a client is to?
Take apical pule and withhold med is pulse is <60
36. The nurse is performing a respiratory assessment on a new client who has come to the clinic. On inspection of the anterior and posterior chest, she notices the symmetry of the chest is equal from front to back and from shoulder to shoulder like the shape of a barrel. The nurse knows the most common lung disease process causing this change in chest symmetry is?
COPD
37. A nurse is reinforcing health teaching regarding skin cancer to a group of clients. Which of the following should the nurse identify as the leading cause of skin cancer?
Sun exposure
38. Which of the following is potassium sparing diuretic?
Aldactone
39. There are many types of wound dressings and therapies in evidence-based wound care. The wound vac has been around many years and is one of the best ways to heal a wound 60% faster than conventional dressings because? (select all that apply)
-Negative pressure increases epithelial cell multiplications forming granulation tissue
-Reduces edema in the wound and improves blood flow
40. A nurse is collecting data from a client who present to the provider’s office for evaluation pf multiple nevi. Which of the following findings should the nurse report to the provider as a possible sign of malignancy?
Irregular borders
41. Which breath sounds are usually heard over the anterior third of the chest near the sternum and also scapular posteriorly, and have inspiration and expiration of equal duration?
Bronchovesicular [Show Less]