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25 Cards in this Set
- Front
- Back
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The LPN caring for a 69 year-old patient admitted to the extended stay facility, notices that he has an unsteady gait. Select each of the following that are appropriate nursing actions for the LPN in this situation. (Select all that apply)
A. ensure the client’s room is free of clutter or obstacles B. Provide adequate lighting to the client’s room. C. Make sure the call light stays on the nightstand at all times. D. Place throw rugs around the client’s room to make him feel more at home. E. Have the client sit in a chair with a vest restraint applied |
A and B
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On taking a client’s blood pressure during am assessment, the LPN reads it as: 160/90. How long should the nurse wait to re-take the blood pressure?
A. 30 seconds B. 45 seconds C. 1 minute D. 2 minutes |
D
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A client with Parkinson’s disease is admitted to an extended-stay nursing facility. Up until this point she has been living on her own. Which of the following assessments is most significant in developing the plan of care?
A. The client states she dislikes beef but will eat it once in awhile if it is cooked well. B. The client talks frequently about how much she misses living on her own. C. The client has a difficult time eating at dinner due to tremors. D. The client states her only living relative is her daughter who lives across the state and seldom visits. |
C
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The term to document an irregular heart rate is ______________.
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Dysrhythmia or arrhythmia
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The physician prescribes the following for a client: Regular insulin 15 units mixed with NPH insulin 20 units subcutaneously at 7 am and 7 pm. The LPN preparing the medication for administration draws up the medication into the same syringe. Arrange the following answer choices into the order that is correct for mixing these medications from separate vials.
A. Inject air into the vial of regular insulin B. Draw 15 units of medication from the vial of regular insulin C. Inject air into the vial of NPH insulin D. Draw 20 units of medication from the vial of NPH insulin |
C, A, B, D
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Two days ago the physician prescribed changes to the insulin regimen of a diabetic client. The new regimen involves the following order: Humulin 70/30 15 units SC BID at 9:00. At midnight the client complains of “ not feeling right”. The client’s skin is cool and clammy. Which of the following nursing actions is appropriate for the LPN to include in the client’s care for the next 24 hours?
A. Encourage an HS snack B. Hold the 9 am dose C. Decrease the am insulin dose to 10 units D. Give the client Humulin R insulin instead of Humulin 70/30 |
A
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The LPN administers the prescribed dose of NPH insulin to a client at 0700.
At what time should the peak effects of this medication be expected to take place? A. 1700 (5pm) B. 2100 (9 pm) C. 1400 (2 pm) D. 1100 (11 am) |
A
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The nursing assistant runs out a hospital room yelling that the patient fell to the floor. The LPN is rehearsing in her mind the order of nursing actions that should be performed when at the client’s side. Arrange the following into the correct order of priority, with the highest priority action listed first.
A. Assess airway patency B. Assess for injury C. Move the client into the bed. D. Check heart rate and blood pressure E. Call the client’s physician |
A, D, B, C, E
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Mr. G. is a client in a long-term nursing facility who requires tube feedings via his PEG (percutaneous endoscopic gastrostomy) tube. Which of the following would the LPN know to watch for as the most common complication of tube feedings?
A. Constipation B. Loose, watery stools C. Vomiting D. excessive belching |
B
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The LPN is preparing to administer Vancomycin 1 gram mixed in 500 ml of IV solution. The medication is to be administered over 90 minutes. At what rate should the medication be set at in drops per minute with a drop factor of 15 gtt/ml?
A. 15 gtt/min B. 33 gtt/min C. 56 gtt/min D. 83 gtt/min |
D
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While looking over a pt.’s lab findings, the LPN notices that the serum potassium of the client is 4.1 mEq/L. Which of the following is the most appropriate nursing action after discovering this information?
A. Document this normal finding in the medical record. B. Call the physician immediately for an order to increase this dangerously low potassium level. C. Check that the client is oriented. This reading is critically high and could cause confusion. D. This value is a little low. Encourage the client to drink 12 oz. of orange juice and eat a banana to increase the serum potassium level. |
A
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What is the most appropriate position for a client to assume when receiving a rectal suppository?
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Lying on the left side with the right leg flexed, or Sims
position |
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Which of the following are appropriate steps that are involved in irrigating a client’s eye?
A. Have the client tilt his head toward the opposite eye. B. Wash hands and put on gloves C. Irrigate with the solution until the eye is no longer reddened. D. Place the drops of solution into the center of the eye. E. Place the drops of solution into the inner corner of the eye. F. Offer a tissue to the client |
B, E, F
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A client with a decubitus ulcer on his coccyx has wet-to-dry dressings changed daily. An appropriate response from the LPN when the client asks about the purpose of this type of dressing would be;
A. “this dressing helps protect the wound.” B. “this dressing absorbs drainage from the wound.” C. “This dressing aids in the removal of dead tissue from the wound.” D. “ This dressing cleans the wound and prevents infection.” |
C
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The LPN overhears a student nurse conversing with a client. The client is expressing concern over her teenage son being home alone while she has been in thehospital. The student nurse replies, “Don’t worry, everything will turn out all right.” Which of the following tactics does this represent?
A. Giving common advice B. Giving unwarranted reassurance C. Acknowledging D. Reflecting |
B
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A client with recurrent DVTs is placed on anticoagulant
therapy. Which of the following values indicates that warfarin (Coumadin) is at a therapeutic level for anticoagulation? A. International normalized ration (INR) of 1.6 B. Prothrombin time (PT) of 13 seconds C. Activated partial thromboplastin time (APTT) of 36 seconds D. International normalized ration (INR) of 2.4 |
D
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A client is receiving aminophylline 500 mg IV mixed in 500 ml. over 12 hours. How much medication does the client
receive ? A. 500 mg/hr B. 60 mg/hr C. 42 mg/hr D. 0.7 mg/hr |
C
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While monitoring a client’s urinary output, the nurse is aware that an hourly output of less than which of the following amounts should be reported to the physician?
A.15 ml. B. 30 ml C. 60 ml D. 100 ml. |
B
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The physician orders urinary catheterization to obtain a urine sample from a female client. In preparation for the procedure the nurse should place the client in the:
A. Dorsal recumbent position B. Supine position C. Lithotomy position D. Sims position |
A
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The LPN is teaching Mr. E. how to insert his new hearing aid. Arrange the following choices in the correct order for completing this task.
A. Turn the hearing aid on and turn the volume up. B. Line up the earmold with the corresponding parts of the ear. C. Slightly rotate the earmold forward. D. Rotate the earmold backward. E. Insert the ear canal portion of the earmold. F. Turn the hearing aid off and the volume all the way down. |
F, B, C, E, D, A
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Which of the following actions by the LPN would demonstrate recognition of the most important method for controlling recognition of the most important method for controlling the spread of infection?
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D
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The nurse reviews the care plan of a post-op client after internal pacemaker placement. The LPN recognizes that the client is in the evaluation stage of the nursing process. Which of the following would NOT be an appropriate outcome to be expected from this client’s plan of care?
A. The client states that he will seek medical attention if he experiences palpitations. B. The client’s white blood cell (WBC) count is 12,000/mm. C. Pulse is 60 to 70 BPM and regular D. Client identifies the bulge in his chest as the pacemaker insertion site. |
B
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The LPN is assisting a quadriplegic patient with passive ROM exercises. The LPN moves the client’s left leg away from the midline of the body. Which of the following ROM exercises is this an example of?
A. Adduction B. Abduction C. Pronation D. Eversion |
B
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Which of the following pressure points is most likely to be at risk for developing a pressure wound while a client is in the prone position?
A. Occiput B. Elbows C. Toes D. coccyx |
C
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Mrs. S. visits the clinic stating that she has not had a bowel movement in two days. The physician puts the client on a diet that is high in fiber. The LPN prepares dietary instruction on this type of diet.
Which of the following includes some of the best food choices? A. English muffin, chicken, canned carrots B. Pineapple, squash, cheddar cheese C. Corn flakes, potatoes, bagels D. whole grain bread, brown rice, oatmeal |
D
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