Medical-Surgical Questions with Rationale 70 questions: 1. A male client who had a stroke is incontinent of urine.

Which action should the practical nurse (PN) implement in providing bladder training? A) Insert a Foley catheter at night to prevent accidents. B) Offer the client the commode or urinal every two hours. C) Decrease the clients oral fluid intake to one liter per day D) Instruct the client to hold his urine as long as possible. During a bladder training program, the commode or urinal should be offered every two hours (B) to establish a routine in bladder emptying and prevent urinary accidents. (A, C, and D) are not indicated. Correct Answer(s): B

2. A client with Parkinson's disease asks the practical nurse (PN) to explain how this disease causes his muscles to malfunction. Which underlying pathophysiology should the PN use as a basis for the explanation? A) Synaptic levels of norepinephrine decrease in the neuromuscular junction. B) Cerebellar levels of acetylcholine rise and inhibit voluntary movement. C) Degeneration of the basal ganglia leads to a decrease in dopamine levels. D) Neuronal signals from the cerebral cortex increase acetylcholine. Parkinson's disease is caused by a degeneration of the basal ganglia (C) and a decrease in dopamine (C), a neurochemical transmitter that affects coordinated and fine voluntary skeletal muscle movements. (A, B, and D) are inaccurate. Correct Answer(s): C

3. A male client is one day postoperative for surgical repair of a fractured femur when he suddenly experiences dyspnea, coughing, chest pain, and hemoptysis. Based on this data, what nursing diagnosis should the practical nurse address for this client? A) Knowledge deficit related to smoking cessation noncompliance. B) Anxiety related to internal cues that symbolize an aspect of trauma. C) Decreased cardiac output related to dysrhythmia. D) Impaired gas exchange related to altered blood flow to alveoli.

Pulmonary embolism is a postoperative complication that results when a clot becomes mobilized and lodges in the pulmonary capillary bed. Impaired gas exchange (D) results from the infarction of pulmonary tissue. (A, B, and C) are not related to this client's presenting signs and symptoms. Correct Answer(s): D

4. Which client medical diagnosis is a contraindication for peritoneal dialysis in a client with chronic renal failure? A) Anemia. B) Peritonitis. C) Diabetes mellitus. D) Hypercholesterolemia. Peritoneal dialysis is contraindicated for a client in renal failure with peritonitis (B), which compromises the effectiveness of the peritoneum as the semipermeable membrane for the exchange of solutes and waste products between the blood and peritoneal dialysate. (A, C, and D) are not contraindications for peritoneal dialysis. Correct Answer(s): B

5. A male client who has been taking a four-drug regimen for tuberculosis (TB) tells the practical nurse (PN) that he has finished the first drug, isoniazid, and will start taking rifampin next. How should the PN respond? A) Observe for side effects, such as an orange discoloration of urine. B) A vitamin B supplement should be added to the daily medications. C) TB is contagious until all four medications are completed. D) The four-drug protocol should be taken concurrently. To prevent resistant strains of tuberculosis, a client with tuberculosis is initially prescribed a four-drug regimen, which requires strict compliance. Information about the concurrent administration of all of the four-drugs in this treatment plan (D) should be reinforced with the client and the healthcare provider notified of the client's past use of the protocol. (A and B) provide additional information for the client, but (D) is the most important information to convey to the client. Although partial use of the medication may be less effective (C), the client's use of the medication must be addressed.

Correct Answer(s):

6. The practical nurse (PN) auscultates the abdomen of a client who had a barium swallow 24 hours ago and determines the client has decreased bowel sounds. The client reports having no bowel movements for 2 days. Which nursing intervention should the PN implement? A) Collect a stool specimen for analysis. B) Limit intake of products with caffeine. C) Increase fluid intake to 3,000 ml daily. D) Check digitally for a bowel impaction. Findings such as decreased or absent bowel sounds and reports of constipation after barium swallow are indicative of a barium impaction, which can be confirmed by a digital check (D). Although stool analysis confirms the presence of barium, the client is unable to have a bowel movement (A). (B and C) may reduce the risk of constipation, but do not address the consequences of retained barium. Correct Answer(s): D

7. Which client should the practical nurse question a PRN prescription for sumatriptan (Imitrex) for migraine headaches? A) 30-year-old with bronchial asthma. B) 40-year-old with diabetes mellitus. C) 50-year-old with Prinzmetals angina. D) 60-year-old with chronic kidney disease. Imitrex reduces pain and other associated symptoms of migraine headache by binding to serotonin receptors and triggering generalized vasoconstriction, which can cause coronary vasospasm in clients with Prinzmetal's or variant angina (C). (A, B, and D) are inaccurate. Correct Answer(s): C

8. An older female client with osteoporosis asks the practical nurse (PN) to explain why she is now 2 inches shorter than when she was younger. What information is best for the practical nurse (PN) to provide? A) Loss of calcium in the bones causes the change.

B) Bones get shorter with age due to wear and tear. C) Less fluid in each of the disks between the vertebrae occurs with degeneration. D) It is a combination of wear and tear and calcium loss that causes the change. A biological theory of aging includes the wear-and-tear theory, which explains that after repeated use and damage, body structures and functions wear out because of stress. A normal spine at 40 years of age and osteoporotic changes at 60 and 70 years of age can cause a loss of as much as 6 inches in height. Small losses in the thickness of each of the intervertebral disks, which results from changes in disk consistency, erosion, and osteoporosis, can lead to significant changes in height (D). Calcium changes (A) and wear and tear (B and C) alone do not support significant height loss in aging, but a basic explanation of disk degeneration that combines several factors provides the client with the best information. Correct Answer(s): D

9. A client is scheduled for a transurethral resection of the prostate (TURP). What statement by the client reveals to the practical nurse that the client needs additional information? A) I need to drink a lot after surgery. B) My urine should be red after surgery. C) My incision will probably be painful. D) I should have a catheter after surgery. Transurethral resection of the prostate (TURP) is performed by inserting a rectoscope through the urethra. No incision is made, so the client's statement about an incision (C) indicates the need for more information about the procedure. Liberal oral fluids are often encouraged (A) after surgery to prevent infection. Postoperatively, urine is blood-tinged (B) due to resection and traumatized urinary membranes. A client with TURP should have an indwelling catheter (D) for drainage and bladder irrigation to prevent occlusion of the catheter with blood clots. Correct Answer(s): C

10.The practical nurse (PN) is reviewing preoperative instructions with a male client who is having surgery today. What question should the PN ask the client to best evaluate his understanding of the surgery?

A) Do you understand why you are having surgery? B) Have you undergone this type of surgery in the past? C) What do you know about the surgery you are having? D) What symptoms brought you to the hospital for surgery? Although it is the surgeons responsibility to explain the surgery to the client, it is a nursing responsibility to determine whether the client understands what he has been told about his surgery. Asking openended questions is an important step in eliciting what the client understands (C). (A and B) are closed end questions and will elicit one word responses. (D) asks the client to explain the admission related to his need for surgery, but not his understanding about the procedure. Correct Answer(s): C

11. Which behavior demonstrates hopelessness in an older client with a terminal disease? A) Demanding extra attention.

B) Seeking alternative care activities.

C) Complaining about the treatment plan.

D) Failing to follow medical recommendations.

Hopeless individuals tend to be passive and uninterested in seeking care or following through with recommendations (D). Hopelessness often does not promote (A, B, and C).

Correct Answer(s):

12. The practical nurse (PN) is reviewing the health history of a client with coronary artery disease (CAD). Which finding should the PN identify that places the client at risk for stroke? A) Obesity.

B) Breast cancer.

C) Senile dementia.

D) Atrial fibrillation.

Atrial fibrillation causes an increased incidence of microthrombi, which can become embolic and cause a cerebrovascular accident (CVA) or stroke (D). Although (A) is a risk factor for CAD, obesity is not directly related to cerebral infarction. (B and C) are not risk factors for stroke.

Correct Answer(s):

13. Which assessment is most important for the practical nurse (PN) to implement for a client who returns from surgery for an arthroscopic repair of the right knee? A) Evaluation of pain symptoms.

B) Auscultation of bowel sounds.

C) Palpation of both pedal pulses.

D) Observation of body temperature.

Although complications are uncommon after arthroscopic procedures, monitoring for neurovascular compromise is most important. Neurovascular assessments, such as presence of pedal pulses (C), evaluate circulatory integrity of tissues that are distal to the surgical site. Although evaluating the client's pain level (A), bowel function (B), and temperature (D) are components of postoperative care, compromised circulation or nerve innervation due to the surgery require immediate action to prevent permanent damage to tissues.

Correct Answer(s):

14. Which information should the practical nurse (PN) offer a female client who is at risk for recurrent urinary tract infection (UTI)? (Select all that apply.) A) Use vinegar solution douche regularly.

B) Avoid wearing tight-fitting jeans.

C) Limit caffeine and alcohol.

D) Void before and after intercourse.

E) Wipe the perineum from front to back.

Correct selections are (B, C, D, and E). Voiding before and after intercourse (D), avoiding caffeine and alcohol (C), and not wearing tight jeans (B), as well as wiping the perineal area from front to back (E), reduce UTI risk. Frequent douching (A) does not reduce a client's risk for frequent UTIs. Correct Answer(s): B, C, D, E

15. The practical nurse (PN) is obtaining deep tendon reflexes for a client with type 1 diabetes mellitus. Which finding indicates to the PN that the client has peripheral neuropathy? A) Clonus noted at each ankle.

B) Asymmetric reflex response.

C) Hyperactive reflexes at the knee.

D) Hypoactive reflexes at the Achilles tendon.

Diabetes mellitus can cause bilateral peripheral neuropathy indicated by hypoactive deep tendon reflexes (D) at the Achilles tendon. (A, B, and C) are inaccurate.

Correct Answer(s):

16.

An adult client with otitis media has thick, yellow drainage from the right ear canal. What additional findings should the practical nurse (PN) expect to identify? A) Pain relief after ear drainage begins.

B) Periauricle skin excoriation.

C) Increased sensitivity to sound.

D) Increased pain with movement of the pinna.

Otitis media is an infection of the middle ear that creates an increased pressure behind the tympanic membrane, which can rupture and drain purulent exudate. Acute ear pain (A) that lessens when ear drainage occurs is a sign of a ruptured tympanic membrane. (B, C, and D) are not expected findings with otitis media and acute tympanic membrane rupture.

Correct Answer(s):

17. An older client who has had a cataract in the right eye for several years tells the practical nurse (PN), Now I have lost the sight in my right eye because I waited too long for treatment. What information should the PN provide?

A) Prompt treatment can save the sight in both of eyes.

B) Nothing can be done once sight is lost in the affected eye.

C) Surgery can restore vision with corrective lens implants or glasses.

D) Explain that surgery cannot provide optimal results immediately.

Removal of a cataract results in restoration of vision with corrective lenses based on the client's underlying error of refraction and retinal integrity. (A and D) are vague and do not focus on the client's fear and specific treatment. (B) is incorrect.

Correct Answer(s):

18. A practical nurse (PN) is coordinating the care of four clients on an oncology unit. Which neutrophil count should the PN identify as a risk for a life-threatening infection in one of the clients? A) 500/mm3.

B) 1000/mm3.

C) 2000/mm3.

D) 3000/mm3.

A neutrophil count of 500/mm3 (neutropenia) (A) places a client at risk for a life-threatening infection. (B, C, and D) are within normal values.

Correct Answer(s):

19. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/minute. During the bed bath, the client complains of shortness of breath. Which action should the practical nurse (PN) implement? A) Increase the flow of oxygen by 2 L/min.

B) Suction the trachea for several minutes.

C) Document the symptoms after the bath.

D) Assist the client into a Fowlers position.

Fowlers position (D) eases breathing by allowing greater expansion of the chest cavity. Both (A and B) increase the client's shortness of breath because an increased oxygen flow (A) reduces the respiratory drive for a client with COPD while suctioning (B) removes air from the airways. Although documentation (C) should be implemented, the client's distress should be addressed by repositioning the client.

Correct Answer(s):

20. While completing preoperative preparation for a client admitted for same-day surgery, what evaluation statement should the practical nurse identify as an important outcome? A) Reports optimal rest in the hours before surgery.

B) Asks questions regarding the surgical experience.

C) Leaves the nursing unit for the surgical department on time.

D) Reads all surgical literature before the operation takes place.

Preoperative preparation should be planned to allow the client and family time to ask questions and receive appropriate feedback (B). (A, C, and D) are not the most important client outcomes of preoperative care.

Correct Answer(s):

21. The practical nurse (PN) is reviewing the admission laboratory results for a client with cirrhosis of the liver. Which finding should the practical nurse (PN) report to the healthcare provider? A) Hemoglobin of 12 grams/dl.

B) Serum potassium of 4 mEq/L.

C) Elevated serum ammonia.

D) Urobilinogen.

Serum ammonia levels (C) are elevated in conditions that result in hepatocellular injury, such as cirrhosis of the liver. (A and B) are normal. (D) is an expected finding in a client with cirrhosis and jaundice.

Correct Answer(s):

22. Which finding should the practical nurse (PN) identify as typical for a client who is hypoxic? A) Temperature of 103 F.

B) Hemoglobin of 10 grams/dl.

C) PO2 of 80 mmHg.

D) PCO2 of 30 mmHg.

A decreased hemoglobin (B) reduces oxygen carrying capacity, causing tissue hypoxia. (A, C, and D) are not typical findings of hypoxia.

Correct Answer(s):

23. What equipment should the practical nurse (PN) ensure is the room for a client after a thyroidectomy? A) Tracheostomy tray.

B) Padded tongue blades.

C) Closed chest drainage system.

D) Sterile gauze.

A complication in the immediate postoperative period after a thyroidectomy is airway obstruction, so a tracheostomy tray (A), oxygen, and suction equipment should be available in the client's room. (B, C, and D) are not necessary at the bedside after a thyroidectomy.

Correct Answer(s):

24. A male client who is 6 hours post radical nephrectomy has a urine output of 20 ml/hour and his blood pressure has changed from 134/90 to 100/56 in the past hour. Which action should the PN implement? A) Notify the healthcare provider of the changes.

B) Check the urinary catheter for kinks or blockage.

C) Obtain the client's vital signs and output in one hour.

D) Verify the patency and rate of the IV infusion.

These findings indicate bleeding and poor renal perfusion, so the healthcare provider should be notified (A). (B, C, and D) should be implemented, but the client needs immediate prescribed treatment from the healthcare provider.

Correct Answer(s):

25.

The practical nurse (PN) is implementing a focused assessment of a client's musculoskeletal system. Which family history finding should the PN identify as an increased risk factor for the client? A) Osteoporosis.

B) Osteomalacia.

C) Osteomyelitis.

D) Bony tuberculosis.

A familial predisposition is associated with an increased risk for osteoporosis (A). (B, C, and D) do not address the concepts of health and illness.

Correct Answer(s):

26. Which finding for a client with heart failure (HF) should the practical nurse (PN) report to the charge nurse? A) Dry nonproductive cough.

B) Respirations at 22 breaths/minute.

C) Blood pressure of 145/90 mmHg.

D) Distended neck veins while upright.

A client who experiences jugular vein distention with the head of the bed elevated (D) is showing signs of increased preload associated with HF that indicates an increased workload on the heart. (A, B, and C) are not as significant as (D).

Correct Answer(s):

27. The practical nurse (PN) is reviewing the side effects associated with chlopromazine (Thorazine) rectal suppository for a client with nausea and vomiting. Which information should the PN review with the client? A) Limit fresh fruit and dietary roughage intake.

B) Report any signs of urinary frequency.

C) Minimize exposure to sunlight during therapy.

D) Eat a balance diet to minimize weight loss.

The most common adverse effects of chlorpromazine (Thorazine) are sedation, orthostatic hypotension, and anticholinergic effects, such as dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia and photosensitivity. Clients should be advised to minimize unprotected exposure to sunlight (C). The use of a rectal suppository may stimulate peristalsis, but Thorazine is more likely to slow GI motility, causing constipation, so (A) is not indicated. Information about other anticholinergic side effects, such as dry mouth, blurred vision, urinary hesitation, not (B), and tachycardia, should be discussed. Weight gain, not (D), is a common side effect.

Correct Answer(s):

28. What is the priority data that the practical nurse (PN) should obtain for a client with a cervical spinal cord injury (SCI)? A) Mental status and pupil reaction.

B) Heart rate and rhythm.

C) Muscle strength and reflexes.

D) Respiratory pattern and airway.

The priority data to obtain for a client with a cervical SCI are respiratory status and airway patency (D). Clients with cervical spine injuries are at risk for respiratory compromise due to impairment of diaphragm movement. (A, B, and C) are not the priority.

Correct Answer(s):

29. After a stroke, a male client with left hemiplegia ignores his left leg and arm. He is unable to use his right arm to assist with moving his left arm or leg. Which descriptor should the practical nurse (PN) document to describe this behavior? A) Mood changes.

B) Sensory deficits.

C) Unilateral neglect.

D) Behavioral changes.

A client's failure to recognize or respond to stimuli on the affected side of the body after a stroke is an example of unilateral neglect (C), which should be documented and the example included in a narrative note. (A, B, and D) are inaccurate.

Correct Answer(s):

30. Which action should the practical nurse (PN) implement to reduce the risk of infection for a client who is receiving total parenteral nutrition (TPN)? A) Administer antibiotics secondary to the TPN fluid.

B) Replace the peripheral cannula every 48 hours.

C) Change the transparent dressing every 72 hours.

D) Use a semipermeable dressing on the insertion site.

To prevent infection, TPN sterile dressing changes should be implemented every 3 to 7 days using a transparent dressing (C), which allows inspection of the site for signs of redness, swelling, foul odor, or purulent drainage. (A and B) are incorrect procedures for TPN. (D) does not address the concept of infection control.

Correct Answer(s):

31. A client with major burns is receiving cimetidine (Tagamet). Which finding should the practical nurse (PN) obtain to best evaluate the effectiveness of the medication? A) Soft, non-tender abdomen.

B) Change in stool frequency.

C) Hyperactive bowel sounds.

D) Absence of blood in the stool.

In burns, Curling's ulcer, a type of gastroduodenal stress ulcer, is caused by a generalized stress response resulting in decreased production of mucus and increased gastric acid secretion, which can cause epigastric pain, gastric ulceration, and bleeding. Cimetidine (Tagamet), a histamine blocker, reduces gastric acid secretion and is used for prevention of Curling's ulcers associated with severe trauma, such as major burns. Absence of blood in the stool (D) or the occurrence of black, tarry stool indicates the medication is effective. Although abdominal findings (A), change in stool frequency (B) or bowel sounds (C) provides information about the effectiveness of therapy, the best evaluation of the prevention of GI distress and ulceration is the absence of blood in the stool.

Correct Answer(s):

32. An older client with presbyopia receives a prescription for corrective lenses. Which information should the practical nurse provide that explains the expected results of the corrective lenses? A) Helps to sharpen distance vision.

B) Improves both near and distance vision.

C) Corrects vision for reading and close work.

D) Assists with bilateral accommodation.

Due to aging of the lenses and loss of elasticity, presbyopia changes reduce the lenses' ability to accommodate, which makes close vision blurry. Corrective lenses improve visual acuity for reading and in close work (C). (A, B, and D) are inaccurate.

Correct Answer(s):

33. The practical nurse (PN) is caring for a client with chronic obstructive pulmonary disease (COPD). To reduce carbon dioxide (CO2) retention in the lungs, which information should the PN reinforce? A) Use pursed-lip and abdominal breathing.

B) Maintain a sitting position with the arms supported.

C) Drink at least three liters of fluid daily.

D) Intersperse rest between periods of physical activity.

Pursed-lip breathing used during diaphragmatic or abdominal breathing (A) provides mild resistance through partially closed lips to prolong exhalation and increase airway pressure, which delays airway compression and reduces air trapping. Although (B, C, and D) are helpful, a client with COPD should use this effort with expiration to reduce CO2 retention caused by the loss of elasticity of the alveoli.

Correct Answer(s):

34. The practical nurse (PN) determines that a client's nasogastric tube (NGT), which is attached to low intermittent suction, has a decreased amount of drainage in the collection unit. Gastric secretions have pooled in the tubing and do not move with the onset of intermittent suction. Which action should the PN implement? A) Clamp the NGT and adjust the suction in the wall outlet.

B) Remove the NGT and prepare to reinsert a new tube.

C) Assess the placement of the NGT.

D) Irrigate NGT with 50 ml of normal saline.

The NGT should be assessed for proper functioning if gastric secretions become stagnant in the tube. Determining placement of the tube (C) is the first action. (A, B, and D) are actions that may need to be implemented based on the evaluation of the NGT.

Correct Answer(s):

35. What information should the practical nurse (PN) reinforce with a client who is recently diagnosed with diabetes mellitus (DM)? A) Diabetes can be cured by the administration of insulin.

B) Diabetes can accelerate the onset of presbyopia.

C) Diabetes increases the risk for cardiovascular disease.

D) Diabetes affects carbohydrate metabolism, not protein or lipids.

Glycemic control is vital with DM because hyperglycemia promotes lipid mobilization and hyperlipidemia, which increases the client's risk for damage to the lining of arteries, causing atherosclerotic cardiovascular disease (C). (A, B, and D) are inaccurate.

Correct Answer(s):

36. Which action should the practical nurse take when handling a sample of cerebrospinal fluid (CSF) collected for diagnostic testing from a client? A) Implement standard precautions with the CSF specimen.

B) Provide the client with instructions on droplet transmission.

C) Use aseptic technique while transporting the collection tubes.

D) Send specimen to the laboratory STAT to prevent sample deterioration.

Standard precautions should be implemented for any potential contact with all body fluids (A). (B and C) are not indicated. (D) does not address the concept of safety.

Correct Answer(s):

37. The practical nurse (PN) is reviewing laboratory results for a client admitted with possible meningitis and identifies that the cerebrospinal fluid (CSF) findings are positive for bacteria. Which action is most important for the PN implement? A) Direct others to use safety precautions.

B) Implement droplet precautions.

C) Ensure the room is quiet and dark.

D) Report the client's positive Kernig's sign.

Respiratory isolation (A) should be implemented for a minimum 24 hours of effective antibiotic therapy. (A, C, and D) should be implemented but do not address the priority of implement infection control measures.

Correct Answer(s):

38.

The practical nurse (PN) is reviewing discharge instructions with a client after out-patient surgery. Which client response indicates to the PN the need for teaching reinforcement? A) The bandage should be changed daily.

B) A normal diet can be started tomorrow.

C) Family assistance should be available.

D) Pain medication should be taken every day.

Pain should be less with each subsequent postoperative day, so the client may not need to take pain medication every day (D), which indicates an opportunity to reinforce teaching. (A, B, and C) indicate client understanding.

Correct Answer(s):

39. A client who experienced a thrombolic stroke has received recombinant tissue plasminogen activator (TPA) (Alteplase) two hours ago in the emergency center. Which priority precaution should the practical nurse implement for this client on admission to the medical unit?

A) Disuse syndrome.

B) Risk for infection.

C) Fall precautions.

D) Bleeding precautions.

TPA increases the client's risk for bleeding, so (D) should be implemented for thrombolytic and anticoagulant therapy. (A, B, and C) should be included in the plan of care for this client, but the risk for bleeding is the most immediate risk related to the client's recent thrombolytic therapy.

Correct Answer(s):

40. Which client should the practical nurse consider at greatest risk for bacterial cystitis? A) A middle-aged female who has never been pregnant.

B) An older female who does not use estrogen replacement.

C) An older male with heart failure.

D) A male who uses sildenafil (Viagra).

Postmenopausal women who do not use hormone replacement therapy are at an increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina (B). (A and C) are not relevant. Urinary tract infections (UTI) are reported in 3% of men on sildenafil (Viagra) (D) compared to the incidence of UTI in postmenopausal women.

Correct Answer(s):

41. A male client returns to the surgical nursing unit after having a thyroidectomy. Which action is most important for the practical nurse to implement? A) Check the back of the neck for bleeding.

B) Determine whether the client can speak.

C) Assess the client's respiratory status.

D) Ask the client if he has pain.

Postoperative complications after a thyroidectomy include laryngeal edema. The priority assessment is monitoring the client's respiratory status (C), including airway obstruction and oxygen saturation. Assessment for bleeding (A), ability to speak (B), and pain (D) are important actions upon return from surgery, but respiratory assessment takes priority.

Correct Answer(s):

42. A client with newly diagnosed essential hypertension is learning to cope with stressful situations in his life. Which activity should the practical nurse (PN) implement to help the client learn constructive coping? A) Role play a situation the client identifies as stressful.

B) Have the client list feelings indicating response to stress.

C) Discuss with the client the behaviors used to respond to stress.

D) Review maladaptive coping strategies that the client uses.

Role playing is an effective learning strategy that is useful in introducing and solidifying new coping mechanisms that the client can use. (B, C, and D) identify the client's stressors but are not effective learning activities.

Correct Answer(s):

43. Which finding prompts the practical nurse (PN) to check the nasogastric tube (NGT) placement? A) The client has vomited.

B) The pH of aspirated fluid is 6.5.

C) The fluid has a grassy green appearance.

D) The abdomen is distended.

A NGT can become displaced with vomiting (A) and NGT placement should be verified. The pH of fluid aspirated from the stomach should be 5 or lower, but does not impact placement (B). Fluid aspirated from the stomach can have a grassy green, brown, or clear, mucoid-flecked appearance (C). (D) is not an uncommon finding for a client with a NGT.

Correct Answer(s):

44. The practical nurse (PN) is reviewing the plan of care for a client scheduled for a surgical amputation of the left lower leg. Which nursing diagnosis should the PN use as the highest priority for this client after the surgery? A) Impaired walking.

B) Impaired adjustment.

C) Disturbed body image.

D) Ineffective health maintenance.

The psychological impact of the removal of a limb results in a Disturbed body image (C), which is the highest priority after surgery that affects the client's ability to cope with walking, adjustment, and health maintenance. The client's perception of alterations in body image influences how the client achieves outcomes related to impaired walking (A), impaired adjustment (B), and ineffective health maintenance (D).

Correct Answer(s):

45. A male client is having an intraocular pressure (IOP) measurement using a tonometer for the first time. The client is fearful that the test hurts and may damage his vision. Which explanation should the practical nurse provide? A) Eyedrops will be prescribed for abnormal IOP readings.

B) A topical anesthetic will be used on the eye surface.

C) The test is quick and does not cause injury or blindness.

D) Reassure the client that the procedure does not hurt.

Pain sensation is eliminated by the use of a topical ophthalmic anesthetic (B) placed in the conjunctival sac prior to the placement of a tonometer when measuring IOP for glaucoma, which is a common cause of blindness if early treatment is not implemented. (A, C, and D) do not provide the client with specific measures taken to prevent discomfort during the procedure.

Correct Answer(s):

46. Which information should the practical nurse (PN) reinforce with a client with a tracheostomy who is learning self-feeding? A) Follow each spoon of food with water.

B) Dilute foods to a thin liquid consistency.

C) Tilt the chin forward toward the chest when swallowing.

D) Inflate the tracheostomy tube cuff tightly before eating.

Tilting the chin toward the chest (C) facilitates swallowing and closes the glottis to prevent aspiration by directing food into the esophagus. Although fluids facilitate swallowing of solid foods (A), liquids are more likely to be aspirated and should be thickened if a client is having difficulty swallowing. Foods should be of a thick consistency, not (B), to enable effective swallowing and reduce the risk of aspiration. Over-inflation of the cuff (D) causes pressure on the tracheal wall.

Correct Answer(s):

47. A client's prescription for warfarin (Coumadin) therapy was discontinued three weeks ago and returns to the clinic for follow-up laboratory tests. Which results should indicate to the practical nurse that the medication has been eliminated from the body? A) Reticulocyte count of 1%.

B) Serum ferritin level of 350 ng/ml.

C) International normalized ratio (INR) of 0.9.

D) Total white blood count of 9,000/mm3.

Warfarin therapy increases the INR. When the effects of warfarin are no longer present, the international normalized ratio (INR) returns to normal levels-between 0.7 and 1.8 (C). (A, B, and D) are inaccurate.

Correct Answer(s):

48. The practical nurse (PN) is caring for a client who is receiving radiotherapy for cancer of the larynx. Which information should the PN provide the client to reduce the undesirable effects of radiation? A) Use sugarless gum and candy to increase salivary secretions.

B) Decrease caloric intake during the course of radiation to prevent nausea.

C) Rinse mouth with commercial mouthwashes to decrease oral inflammation.

D) Apply oil-based lotions to moisturize dry skin areas that are irradiated.

Dry mouth (xerostomia) is often a side effect of external beam radiation to the head and neck. Increasing fluid intake, chewing sugarless gum or sugarless candy (A), or using non-alcoholic mouth rinses or artificial saliva may provide relief. (B, C, and D) are contraindicated for a client receiving external beam radiation.

Correct Answer(s):

49. A male client with diabetes mellitus calls the clinic to report left calf pain after walking around the block. Which additional information should the PN report to the healthcare provider? A) Muscle cramps occur at night when sleeping.

B) Muscles are deconditioned from lack of regular exercise.

C) Shooting pain occurs down the back of one leg when walking.

D) The pain is immediately relieved when he sits down.

Atherosclerosis, secondary to diabetes mellitus, increases the client's risk for peripheral arterial disease, which is manifested by pain precipitated by walking. The pain is immediately relieved when the clients sits down to rest (intermittent claudication) (D) and should be reported. (A, B, and C) occur from different problems.

Correct Answer(s):

50. Which factor should the practical nurse (PN) identify that indicates a client needs to be screened for an aggressive breast cancer? A) Full and pendulous breast tissue.

B) Pre-menopausal breast cancer in her mother.

C) History of pubescent onset at 13 years of age.

D) Breast feed before 20 years of age.

Pre-menopausal breast tumors are stimulated by estrogen and tend to be more aggressive tumors. So women with a first-degree relative who had pre-menopausal breast cancer are at a great risk for a genetic link for aggressive breast cancer (B) and should be screened early. (A) is not relevant. Although (C and D) affect a woman's estrogen exposure, a genetic relationship is the factor that most significantly indicates the client's need to screen for an aggressive breast cancer.

Correct Answer(s):

51. An older male client with osteoarthritis complains of stiffness and pain in his hips, knees, and feet each morning and asks the practical nurse (PN) why just these joints bother him. Which explanation should the PN provide? A) Advanced age eventually causes generalized joint pain. B) Poor circulation may cause pain in the lower extremities. C) Joint damage can occur from years of weight-bearing stress. D) Cartilage of the lower extremities is more likely to wear out.

Osteoarthritis (degenerative joint disease) causes degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone and results from excessive wear and tear to cartilage in weight bearing joints (C). Poor circulation does not affect joint stiffness (B). (A and D) do not provide the client with specific information about his disease.

Correct Answer(s):

52. A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the practical nurse to report to the healthcare provider? A) Pain radiating to the right shoulder.

B) Clay-colored stool.

C) Hard, rigid abdomen.

D) Vomiting bile-stained emesis.

As bile accumulates due to obstruction of the common bile duct, the gallbladder distends and can perforate, which is manifested by a distended, hard, rigid abdomen (C) that should be reported immediately to the healthcare provider. Radiating pain (A) and clay-colored stool (B) are manifestations associated with obstructive jaundice due to cholelithiasis. (D) indicates the obstruction of the common bile duct is reduced.

Correct Answer(s):

53. Which instruction should the practical nurse (PN) reinforce with a female client about skin care after her first radiotherapy treatment? A) Cleanse the area with bar soap and water.

B) Moisten the skin with lotions after treatment.

C) Avoid using ice packs on the exposed area.

D) Protect the skin from exposure to air.

The client should keep the irradiated area of skin dry and clean. Irritants, such as ice packs (C), should also be avoided. (A, B, and C) are not indicated.

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54. A clients results for this morning's platelet count is 30,000/mm3. What action should the practical nurse (PN) implement first? A) Notify the healthcare provider.

B) Institute bleeding precautions.

C) Observe intravenous access sites.

D) Take vital signs as soon as possible.

Bleeding precautions (B) should be implemented first since the low platelet count places the client at risk for bleeding. (A, C, and D) are implemented after (B).

Correct Answer(s):

55. A male client with metastatic gastric cancer is being discharged home, but the client and family members are fearful of managing the clients symptoms at home. What action should the practical nurse provide? A) Ask the healthcare provider to tell the family about the care to give at home.

B) Offer reassurance that they will be able to give daily care and medications.

C) Re-enforce the steps that have been taught about home care for the client.

D) Suggest a referral for the client to have hospice care provided in their home.

A client with metastatic gastric cancer who is terminally ill often experiences difficulty with emotional needs and physical symptoms that require specialized care during the dying process. Hospice services (D) in the home should be offered to the client and family to assist with both physical care and emotional adjustment with this stage of life and death. (A, B, and C) do not address the concerns voiced by the client and family.

Correct Answer(s):

56. The practical nurse (PN) is reinforcing information to a 79-year-old male client with a history of coronary artery disease about his prescribed daily medication regimen. Which medication is most likely to reduce this client's risk factors? A) A potassium sparing diuretic. B) A high daily Vitamin C dose. C) A low protein binding antibiotic. D) A low-dose aspirin given daily.

Low-dose aspirin reduces the risk of platelet aggregation, thereby minimizing clot formation that can result in coronary vessel occlusion (D). Diuretics (A), Vitamin C (B), and antibiotics (C) do not reduce the risk of coronary occlusion or thrombolic stroke.

Correct Answer(s):

57.

The wife of a client with a large brain tumor asks the practical nurse (PN) to explain why the tumor should be surgically removed. What is the best response for the PN to provide? A) Benign brain tumors are readily treatable and have a favorable prognosis.

B) Brain tumors increase cerebral mass, resulting in increased intracranial pressure.

C) Most brain tumors cause death by metastasizing to vital organs, such as the liver or lungs.

D) Malignant brain tumors are usually not treatable surgically and are managed with chemotherapy.

Local effects of cranial tumors are caused by tumor compression that decreases cerebral blood flow and increases intracranial pressure (B), causing seizures, visual disturbances, unstable gait, and cranial nerve dysfunction. Although (A) is a positive response, benign tumors can compromise cerebral tissue integrity and cause sequela. Intracranial brain tumor metastasis to other organs (C) is limited because there are no lymphatic channels within the brain. (D) is inaccurate.

Correct Answer(s):

58. What information should the practical nurse reinforce while reviewing discharge instructions with a client who has a joint dislocation?

A) Calcium supplements should be taken daily. B) Prescribed exercises should be performed daily. C) Cortisone medication side effects should be reviewed. D) Future surgery for removal of fixation devices may be required.

Muscle strengthening exercises are prescribed for dislocations as the most effective method of preventing additional dislocation (B). (A, C, and D) do not address the concepts of mobility and coordination of care.

Correct Answer(s):

59. What complication is most important for the practical nurse to monitor for in a client who has a total hip replacement? A) Depression.

B) Infection.

C) Immobility.

D) Contractures.

Infection associated with total joint replacement is a serious complication that can delay the client's rehabilitation in usual activities of daily living, so monitoring the client for signs of infection (B) is the priority observation. (A, C, and D) are postoperative problems secondary to infection that can be minimized by early physical therapy and activities that maximize the client's range of motion and prevent complications of bed rest.

Correct Answer(s):

60. Before implementing oral feedings for a client who has had a stroke, which action should the practical nurse (PN) implement? A) Cut all food into very small pieces.

B) Verify that the client is able to swallow.

C) Explain the location of all the food on the tray.

D) Position the client in the dorsal recumbent position.

Neurologic damage increases the risk of swallowing disorders. The client's ability to swallow should be evaluated before offering anything by mouth (B). (A and C) can be implemented during feeding. (D) places the client at risk for aspiration.

Correct Answer(s):

61. Which findings should the practical nurse identify in a client with anemia due to a vitamin B12 deficiency? A) Gradual weight gain.

B) Smooth, beefy-red oral cavity.

C) Macrocytic red blood cells (RBC).

D) Paresthesia of hands and feet.

E) Leukopenia.

Correct choices are (B and D). Vitamin B12 deficiency anemia is due to a dietary deficiency or failure to absorb vitamin B12 from the intestinal tract as a result of partial gastrectomy or pernicious anemia. Manifestations of pernicious anemia include glossitis (a smooth, beefy-red tongue) (B), fatigue, paresthesia (D), pallor and jaundice, and weight loss, not (A). The results of a complete blood count (CBC) that show macrocytic anemia (C), leukopenia (E) and thrombocytopenia are indicative of bone marrow failure, not vitamin B12 deficiency. Correct Answer(s): B, D

62. The practical nurse (PN) should place a client in which position for a thoracentesis? A) In a modified Sims' position with arms extended above the head.

B) Sitting upright in a tripod position leaning on an overbed table.

C) In a supine position with the head of the bed elevated 45 degrees.

D) Lying prone in a Trendelenburg position with both arms extended.

A client undergoing thoracentesis is positioned in a tripod position that allows the client to sit upright with the arms on an overbed table (B). (A, C, and D) are incorrect positions.

Correct Answer(s):

63. A male client is admitted with lower right abdominal pain for the past two days. During the focused assessment, the practical nurse (PN) observes that the clients abdomen is rigid with tense positioning. Which action should the PN implement? A) Withhold opioid use that contributes to constipation.

B) Ask the client if he recently ate any gluten products.

C) Determine if the client has biliary colic pain.

D) Keep the client NPO for possible surgery.

The client's symptoms of prolonged lower right abdominal pain accompanied by tenseness and guarding are indicative of possible appendix perforation and peritonitis. The client is should be NPO and prepared for possible surgery (D). (A, B, and C) are not indicated.

Correct Answer(s):

64. A male client with peptic ulcer disease complains of feeling weak and dizzy. The practical nurse (PN) observes that the client is diaphoretic, has a firm abdomen, thready pulse at 104 beats/minute, and blood pressure of 90/50. Which action should the PN implement? A) Place the client in a left side-lying position.

B) Obtain vital signs every 2 hours.

C) Increase the client's oral fluid intake.

D) Notify the healthcare provider.

Peptic ulcer perforation can cause hemorrhage. The client is manifesting signs of hypovolemic shock, a life-threatening emergency that requires intervention, so the healthcare provider should be notified immediately (D). (A, B, and C) delay obtaining life-saving prescriptions.

Correct Answer(s):

65. A male client receives the negative results for his recent fecal occult blood test and calls the clinic to cancel his colonoscopy scheduled for the next day. Which information should the practical nurse provide? A) The colonoscopy should be canceled if he is asymptomatic.

B) A negative result for occult blood does not rule out lesions in the colon.

C) A followup colonoscopy should be scheduled after one month.

D) Two negative fecal occult results are needed to verify no bleeding is occurring.

To determine the presence of colon cancer, a colonoscopy of the entire colon should be visualized and a tissue sample taken for biopsy, if warranted. A negative fecal occult blood result does not rule out the possibility of a lesion in the colon (B). (A, C, and D) are not correct.

Correct Answer(s):

66. A male client with a crushing injury of the right lower leg from a tractor accident complains of numbness and tingling is his right leg and foot. The practical nurse (PN) determines the right leg is pale and he has a weak pedal pulse. What action should the PN take? A) Elevate the leg on pillows.

B) Notify the healthcare provider.

C) Apply warm, moist packs.

D) Document the assessment.

Acute compartment syndrome is characterized by marked sensory deficits, such as paresthesia, which precede vascular and motor signs consistent with compromised neurovascular integrity. Immediate notification of the healthcare provider (B) is essential. Elevation (A) and warm, moist packs (C) are ineffective. Although the findings should be documented (D), the findings should be promptly reported to the healthcare provider for emergent care.

Correct Answer(s):

67.

Which intervention is most important for the practical nurse to implement after giving a client an initial injection for the screening for allergies? A) Have the client remain on-site for 30 minutes after the injections.

B) Remind the client to call the healthcare provider if a rash develops.

C) Assess vital signs every 15 minutes for 1 hour after the injections.

D) Teach the use of epinephrine injection if an allergic reaction occurs.

In skin testing for allergies, symptoms of sensitivity to antigen exposure usually occur within 15 to 30 minutes of exposure. The client should remain on-site (A) at least 30 minutes after receiving the intradermal injection of an antigen to ensure the client's safety and determine the client's sensitivity response. Although reporting a rash (B), teaching injection of epinephrine (D), and monitoring of vital signs (C) may be provided, the most important action is to evaluate the client's initial reaction after exposure to the antigen.

Correct Answer(s):

68.

The practical nurse (PN) is visiting a male client with diabetes who has a new cast on his arm. The clients fingers are pale, cool, slightly swollen, and the radial pulse is strong. What should be the PN do first? A) Send client to the clinic so cast can be bivalved.

B) Apply warm moist heat to the affected arm.

C) Check the client's blood glucose level.

D) Elevate the arm above the level of the heart.

Arm casts can impinge circulation when in the dependent position, so the arm should be elevated above the level of the heart, ensuring that the hand is above the elbow, and reassess the extremity in 15 minutes (D). (A and B) are not indicated at this time. Blood glucose level (C) is not related to this circulatory issue.

Correct Answer(s):

69. Which actions should the practical nurse implement for a client whose fractured tibia is causing swelling of the lower leg?

A) Massage and ice pack. B) Heating pad and massage. C) Ice application and elevation. D) Narcotic analgesia and moist heat.

Standard measures for swelling of a traumatic injury is rest, ice, compression, and elevation (RICE) (C). (A, B, and D) are inaccurate.

Correct Answer(s):

70. The practical nurse (PN) is evaluating the self-care of a client who is recovering at home after a laryngectomy. Which finding indicates to the PN that the client needs additional information? A) A cool mist humidifier is at the bedside.

B) The salt water solution is dated 3 days ago.

C) A Medic Alert bracelet is on the clients wrist.

D) The client's stoma is covered with a crocheted scarf.

Salt water solution (B) should be changed daily to prevent bacterial growth. (A, C, and D) are within accepted parameters for care.

Correct Answer(s):