Physiological Integrity

1313 questions

Question 341Question →

A client with severe generalized weakness is confined to bed. To promote physical comfort and prevent complications related to immobility, which positioning techniques should the practical nurse implement? (Select all that apply.)

Select all that apply

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Answer: Maintain the client in a 30-degree lateral incline position when turning.; Support the calves with a cushion to completely suspend the heels off the mattress.; Restrict the upward angle of the bed's headrest to 30 degrees or lower except when eating.

Answer

The correct positioning techniques include maintaining a 30-degree lateral incline, supporting the calves to suspend the heels, and restricting the headrest angle to 30 degrees or lower.
Proper positioning aims to minimize pressure, friction, and shear forces that lead to skin breakdown and circulatory impairment. A 30-degree lateral incline effectively shifts body weight off the greater trochanter and onto the gluteal muscles. Suspending the heels removes all pressure from a highly vulnerable bony prominence. Limiting the headrest elevation to 30 degrees prevents the client from sliding downward, thereby reducing severe shearing forces on the sacrum.

Step-by-Step Solution

1
Analyze the goal of positioning an immobile client.
The primary goals are to distribute weight evenly, avoid pressure on bony prominences, minimize shearing forces, and maintain unobstructed circulation.
Immobility greatly increases the risk of pressure injuries and deep vein thrombosis without proper intervention.
2
Evaluate each positioning strategy against safety and comfort standards.
The 30-degree lateral incline, heel suspension, and low head-of-bed angle effectively reduce shear and localized pressure. Direct hip pressure and popliteal rolls cause tissue and circulatory harm.
Identifying interventions that prevent complications is within the practical nursing scope of basic care and comfort.

Key Concept

Prevention of Complications of Immobility
Question 342Question →

A practical nurse (PN) is collecting data on a client who is 6 hours postpartum following an uncomplicated vaginal delivery. Which finding is the priority to report to the registered nurse immediately?

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Answer: A gradual increase in heart rate from 78 to 112 beats/minute and a blood pressure decrease from 122/76 to 104/62 mm Hg.

Answer

The finding that requires immediate reporting is the gradual increase in heart rate accompanied by a decrease in blood pressure.
The correct answer identifies subtle but progressive vital sign changes (tachycardia and mild hypotension), which are early, critical indicators of compensatory hypovolemic shock. In a postpartum client, this strongly suggests an undetected hemorrhage. The PN must prioritize this finding and report it immediately to the RN for further assessment and medical intervention, as it directly impacts the client's circulation (ABCs).

Step-by-Step Solution

1
Analyze the client's current clinical status and the timeframe.
The client is 6 hours postpartum, a high-risk period for hemorrhage and physiological fluid shifts.
Establishing the timeframe helps differentiate between normal expected adaptations and acute complications.
2
Evaluate each data finding against expected normal postpartum physiological adaptations.
Saturating one pad in three hours, afterpains during breastfeeding, and a slight temperature elevation up to 100.4°F (38.0°C) are all normal, expected findings.
Normal findings reflect expected healing and hormonal changes, and they do not require immediate urgent reporting to the RN.
3
Identify any findings that compromise Airway, Breathing, or Circulation (ABCs).
The steadily rising heart rate and falling blood pressure indicate a serious circulation issue, specifically compensatory hypovolemia.
Prioritization questions require focusing on ABCs; early signs of shock must be escalated immediately to prevent severe cardiovascular collapse.

Key Concept

Early recognition of hypovolemic shock in the postpartum period
Estimated Time:1m 0s
Question 343Question →

Four hours following an uncomplicated vaginal delivery, a postpartum client reports feeling unusually tired. Upon evaluation, the nurse observes that the client has completely saturated a perineal pad with dark red blood within the last 45 minutes. The current assessment shows a heart rate of 106 beats/minute and a blood pressure of 104/68 mm Hg, a change from the baseline of 82 beats/minute and 126/78 mm Hg. Which action should the nurse take first?

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Answer: Massage the uterine fundus and urgently notify the supervising registered nurse.

Answer

Massage the uterine fundus and urgently notify the supervising registered nurse.
The correct answer addresses the immediate physical need by massaging the fundus to promote uterine contraction while simultaneously escalating the critical situation to the registered nurse. The client's saturated pad and vital sign changes indicate postpartum hemorrhage and early hypovolemic shock, requiring urgent collaborative intervention.

Step-by-Step Solution

1
Evaluate the perineal pad saturation rate.
The pad is saturated in 45 minutes, indicating excessive bleeding.
Saturating a pad in less than one hour is a clinical indicator of postpartum hemorrhage.
2
Analyze the vital sign trends.
Heart rate increased by 24 beats/minute and blood pressure decreased.
Tachycardia and mild hypotension are early compensatory signs of hypovolemic shock due to blood loss.
3
Determine the priority nursing intervention.
Initiate fundal massage and escalate to the RN.
Fundal massage is the immediate action for uterine atony, and the RN must be notified for collaborative management of hemorrhage.

Key Concept

Early recognition and escalation of postpartum hemorrhage
Question 344Question →

A practical nurse is assigned to care for a client who returned to the surgical unit 2 hours ago following a subtotal thyroidectomy. The client reports mild incisional discomfort. Which positioning intervention should the nurse implement to promote comfort and minimize tension on the surgical site?

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Answer: Adjust the bed to a semi-Fowler's angle and stabilize the head and neck using supportive pillows.

Answer

Adjust the bed to a semi-Fowler's angle and stabilize the head and neck using supportive pillows.
Adjusting the bed to a semi-Fowler's angle (approximately 30 to 45 degrees) utilizes gravity to decrease swelling at the surgical site. Stabilizing the head and neck with pillows prevents hyperextension or hyperflexion, keeping the neck in a neutral position. This combination ensures optimal airway patency, reduces tension on the surgical incision, and maximizes client comfort.

Step-by-Step Solution

1
Identify the surgical procedure and its anatomical location.
The client had a subtotal thyroidectomy, which involves an incision in the anterior neck.
Understanding the surgical site is essential for determining the correct positioning to prevent complications.
2
Determine the primary physiological risks associated with the immediate postoperative period.
Risks include localized edema causing airway obstruction, and tension on the suture line causing hemorrhage.
Nursing interventions must be chosen to mitigate these specific, life-threatening complications.
3
Select the position that addresses these risks while promoting client comfort.
A semi-Fowler's position with the head and neck supported in a neutral alignment.
Elevation reduces swelling via gravity, and firm support prevents flexion or hyperextension of the neck.

Key Concept

Postoperative Positioning and Airway Protection

Practice More

Review the early signs of respiratory distress and hypocalcemia following a thyroidectomy.

Alternative Method

When thinking about post-neck surgery care, remember the 'E and N' rule: Elevate (to reduce swelling) and Neutral (to prevent suture tension).
Estimated Time:1m 0s
Question 345Question →

While reviewing the morning chart for a client treated for heart failure, a practical nurse notes a serum potassium result of 3.03.0 mEq/L (reference range: 3.53.5 to 5.05.0 mEq/L). The medication record indicates upcoming scheduled doses of oral furosemide and oral potassium chloride. Which step is most appropriate for the nurse to take?

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Answer: Hold the furosemide dose, give the potassium chloride supplement, and alert the supervising registered nurse.

Answer

The nurse must withhold the furosemide, administer the potassium chloride, and notify the registered nurse.
Holding the furosemide prevents further depletion of the client's already low potassium levels. Administering the potassium chloride addresses the deficit, and notifying the registered nurse ensures proper escalation of a critical laboratory finding.

Step-by-Step Solution

1
Evaluate the morning laboratory results against normal reference ranges.
The client's serum potassium is 3.03.0 mEq/L, which indicates hypokalemia (normal is 3.53.5 to 5.05.0 mEq/L).
Identifying abnormal laboratory values is essential before administering medications that affect fluid and electrolyte balance.
2
Analyze the pharmacological effects of the scheduled medications on the abnormal lab value.
Furosemide is a loop diuretic that causes the kidneys to excrete potassium, which would worsen the hypokalemia. Potassium chloride will help correct the deficit.
Understanding the mechanism of action prevents the administration of a drug that could cause immediate client harm.
3
Determine the appropriate nursing intervention within the practical nurse scope of practice.
The nurse must hold the furosemide, proceed with the potassium supplement, and report the abnormal finding to the registered nurse.
Practical nurses must advocate for client safety by withholding harmful medications and escalating critical clinical data.

Key Concept

Monitoring adverse effects of pharmacological therapies and safe medication administration.
Question 346Question →

The practical nurse (PN) is providing care for a group of clients on a medical-surgical unit. Which of the following actions by the PN demonstrate appropriate risk reduction and safe clinical practice? Select all that apply.

Select all that apply

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Answer: Notifying the registered nurse (RN) immediately regarding a client receiving a loop diuretic whose morning serum potassium level is 2.8 mEq/L (2.8 mmol/L).; Verifying the client's name and date of birth using the identification band prior to providing scheduled oral medications.; Placing a client with right-sided weakness on a scheduled toileting protocol to prevent unassisted ambulation attempts.

Answer

The correct actions are notifying the RN of the critically low potassium level, verifying two client identifiers before medication administration, and implementing a scheduled toileting protocol for a client with weakness.
The correct choices reflect safe clinical practice strictly within the practical nurse scope. Escalating a critically low hypokalemia value, adhering to mandatory two-identifier verification, and implementing proactive fall prevention strategies all directly reduce the risk of harm to vulnerable clients.

Step-by-Step Solution

1
Analyze the PN scope of practice regarding medication administration and delegation constraints.
Intravenous push (IVP) medications require RN-level assessment and are outside the standard PN scope.
Accepting tasks beyond legal scope increases the risk of client harm and violates professional licensure standards.
2
Evaluate vital signs and laboratory data to differentiate between expected variations and critical abnormalities.
A potassium level of 2.8 mEq/L and vital signs showing tachycardia with hypotension are critical findings.
These findings indicate severe physiological compromise (hypokalemia and potential shock) requiring immediate medical or RN intervention.
3
Review standard safety protocols for client identification and fall prevention.
Checking two distinct identifiers and implementing scheduled toileting are mandated safety practices.
Visual recognition bypasses safety checks, leading to medication errors, while unassisted ambulation in weak clients leads to falls. Proper protocols reduce these risks.

Key Concept

Scope of Practice and Clinical Prioritization in Risk Reduction
Question 347Question →

A client with a spinal cord injury at the T4 level reports a sudden, severe pounding headache and blurred vision. The practical nurse (PN) notes the client is profusely sweating and has a flushed face. The client's blood pressure is 208/112 mm Hg. In what order should the PN perform the following actions? Arrange the actions from first to last.

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Answer

The correct sequence is to first elevate the head of the bed, then check the urinary catheter for kinks, notify the registered nurse, and finally monitor the blood pressure frequently.
In the event of autonomic dysreflexia, the primary life-threatening risk is a severe hypertensive crisis that can lead to a stroke. The very first action must always be to elevate the head of the bed to a sitting (high Fowler's) position, as this uses gravity to immediately lower the blood pressure (orthostatic hypotension). Once the client is safely positioned, the practical nurse must quickly assess for and remove the noxious stimulus, which is most commonly a distended bladder caused by a kinked catheter. After these immediate independent bedside interventions are completed, the nurse must notify the registered nurse to coordinate potential pharmacological treatment. Finally, the nurse continues to monitor the blood pressure every 10 to 15 minutes to evaluate the effectiveness of the interventions.

Step-by-Step Solution

1
Elevate the head of the bed to a high Fowler's (sitting) position.
The client is in a sitting position, which promotes orthostatic hypotension.
This is the most rapid and immediate action to lower the dangerously high blood pressure and prevent a cerebrovascular accident (stroke).
2
Check the client's urinary catheter tubing for kinks or obstruction.
The most common noxious stimulus is assessed and potentially resolved.
Bladder distention is the leading cause of autonomic dysreflexia. Removing the stimulus helps resolve the physiological cascade.
3
Notify the registered nurse (RN) of the client's acute symptoms.
The RN is informed of the medical emergency.
The RN and healthcare provider need to be aware, as pharmacological intervention may be required if nursing actions do not relieve the symptoms.
4
Monitor the client's blood pressure every 10 to 15 minutes.
Continuous assessment of the client's hemodynamic status is established.
Frequent monitoring is necessary to determine if the interventions are effective and to ensure the blood pressure is stabilizing.

Key Concept

Prioritization of care for autonomic dysreflexia involves immediate blood pressure reduction through positioning, followed by elimination of the triggering stimulus.
Question 348Question →

The healthcare provider prescribes oral ibuprofen for a toddler who weighs 3333 pounds and has a temperature of 101.2∘F101.2^\circ\text{F} (38.4∘C38.4^\circ\text{C}). The prescribed dosage is 10 mg/kg10\text{ mg/kg} per dose. The available medication is an oral suspension labeled 100 mg/5 mL100\text{ mg}/5\text{ mL}. How many milliliters should the nurse administer for a single dose?

Record your answer to the nearest tenth. Do not include units in the answer.

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Answer: 7.5

Answer

7.5
To find the correct administration volume, the practical nurse must systematically process the data. First, the toddler's weight is converted to standard metric units by dividing by 2.22.2 (33 lbs÷2.2=15 kg33 \text{ lbs} \div 2.2 = 15\text{ kg}). Next, the weight is multiplied by the ordered weight-based dose to find the target milligrams (15 kg×10 mg/kg=150 mg15\text{ kg} \times 10\text{ mg/kg} = 150\text{ mg}). Finally, the nurse calculates the required volume using the supplied concentration: (150 mg÷100 mg)×5 mL=7.5 mL(150\text{ mg} \div 100\text{ mg}) \times 5\text{ mL} = 7.5\text{ mL}.

Step-by-Step Solution

1
Convert the toddler's weight from pounds to kilograms.
33 lbs÷2.2 lbs/kg=15 kg33 \text{ lbs} \div 2.2 \text{ lbs/kg} = 15 \text{ kg}
Weight-based medication dosages must be calculated using kilograms to ensure safe administration limits.
2
Calculate the total required dose in milligrams.
15 kg×10 mg/kg=150 mg15 \text{ kg} \times 10 \text{ mg/kg} = 150 \text{ mg}
The prescription specifies a weight-based dose of 10 mg for every kilogram of body weight.
3
Calculate the administration volume using the available suspension concentration.
(150 mg÷100 mg)×5 mL=7.5 mL(150 \text{ mg} \div 100 \text{ mg}) \times 5 \text{ mL} = 7.5 \text{ mL}
Applying the desired over have formula determines the exact liquid volume needed to deliver the prescribed milligram dose.

Key Concept

Weight-based dosage calculation and liquid medication volume conversion
Question 349Question →

An older adult client is prescribed oral digoxin 0.1250.125 mg once daily. The unit's automated medication dispenser supplies digoxin in scored tablets of 0.250.25 mg. Prior to administration, the practical nurse assesses the client's apical pulse and obtains a rate of 7474 beats per minute. Which action should the practical nurse take?

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Answer: Administer one-half of the scored tablet after verifying two client identifiers.

Answer

The practical nurse should administer one-half of the scored tablet after verifying two appropriate client identifiers.
The correct action combines accurate dosage calculation, appropriate assessment, and strict adherence to medication rights. The prescribed dose is 0.1250.125 mg, and the available tablet is 0.250.25 mg. Calculating the dose (0.125÷0.250.125 \div 0.25) yields 0.50.5, meaning one-half of a scored tablet is required. An apical pulse of 7474 beats per minute is safely above the standard withholding threshold of 6060 beats per minute for digoxin, making it appropriate to administer. Finally, verifying two distinct client identifiers (such as name and date of birth) is a mandatory safety standard before giving any medication.

Step-by-Step Solution

1
Assess the client's heart rate against the medication administration parameters.
The apical pulse is 7474 beats per minute, which is safely above the standard threshold of 6060 beats per minute for withholding digoxin.
Digoxin decreases heart rate, making it dangerous to administer to a client with bradycardia without further medical evaluation.
2
Calculate the correct medication dosage.
The prescribed dose is 0.1250.125 mg. The available tablet is 0.250.25 mg. Using the formula 0.125÷0.25=0.50.125 \div 0.25 = 0.5, one-half of the scored tablet is needed.
Ensures the client receives the exact prescribed dose and prevents medication errors such as toxicity.
3
Ensure strict adherence to medication administration rights.
The nurse must verify the client using two acceptable identifiers, such as the client's name and date of birth.
Bypassing identification rights or using unacceptable identifiers like a room number can lead to severe medication administration errors.

Key Concept

Safe medication administration involves accurate dosage calculation, pre-administration physical assessment, and verifying two unique client identifiers.
Question 350Question →

A practical nurse is providing care for a 75-year-old client who had a bowel resection two days ago. The client's morning vital signs were: blood pressure 104/68 mm Hg, heart rate 96 beats/min, respirations 20 breaths/min, and oxygen saturation 94% on room air. Two hours later, the client suddenly becomes highly restless, confused, and attempts to climb out of bed. Which action should the practical nurse take first?

Show answer & explanation

Answer: Obtain a current set of vital signs including oxygen saturation

Answer

The priority action is to obtain a current set of vital signs including oxygen saturation.
Sudden restlessness and confusion in a postoperative client are classic early signs of hypoxia, hemorrhage, or hypovolemic shock. Because the morning vital signs were already borderline (heart rate of 96 beats/min and oxygen saturation of 94%), the nurse must first collect current physiologic data to determine if the client is rapidly decompensating. This objective data is essential before notifying the registered nurse or the healthcare provider.

Step-by-Step Solution

1
Analyze the baseline clinical data.
The morning vital signs showed a high-normal heart rate and low-normal oxygen saturation, indicating the client was in a borderline compensated state.
Establishing a baseline helps identify subtle trends that precede sudden clinical deterioration.
2
Interpret the new onset of symptoms.
Sudden restlessness and confusion in an older adult are often the first signs of impaired tissue perfusion (shock) or hypoxia.
The brain is highly sensitive to drops in oxygenation and blood flow, presenting as altered mental status before other overt signs appear.
3
Determine the priority nursing intervention.
The practical nurse must first collect objective data regarding airway, breathing, and circulation (vital signs).
According to ABC prioritization, verifying physiologic stability is required before implementing comfort measures or behavioral interventions.

Key Concept

Prioritization of Care and Acute Shock Recognition
Estimated Time:1m 0s
Question 351Question →

A licensed practical nurse is caring for an adult client who underwent an open reduction and internal fixation of a right femur fracture 8 hours ago. During the current assessment, the nurse notes a heart rate of 118 beats/minute, a blood pressure of 96/62 mm Hg, and a respiratory rate of 22 breaths/minute. Additionally, the surgical dressing exhibits a newly formed, 4-cm diameter area of sanguineous drainage. What is the priority action for the nurse to take?

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Answer: Immediately report the assessment findings to the supervising registered nurse.

Answer

Immediately report the assessment findings to the supervising registered nurse.
The client is demonstrating early signs of hypovolemic shock, likely due to postoperative hemorrhage, evidenced by tachycardia, borderline hypotension, and new sanguineous drainage. In the practical nursing scope of practice, recognizing an acute deterioration in client stability requires immediate escalation to the registered nurse or healthcare provider so that emergent interventions (such as fluid resuscitation or surgical evaluation) can be initiated.

Step-by-Step Solution

1
Analyze the client's vital signs and physical assessment findings.
The client has tachycardia (118 beats/minute), borderline hypotension (96/62 mm Hg), and new sanguineous drainage on the surgical dressing.
Identifying abnormal clinical data is the first step in recognizing potential complications.
2
Correlate the findings with potential postoperative complications.
The combination of elevated heart rate, decreasing blood pressure, and fresh bleeding indicates a high risk for hypovolemic shock due to hemorrhage.
Connecting isolated vital sign changes to underlying physiological processes determines the urgency of the situation.
3
Determine the appropriate action based on the practical nurse's scope of practice.
The nurse must escalate the findings to the registered nurse or healthcare provider immediately rather than attempting independent, out-of-scope interventions or delaying care.
Practical nursing standards require reporting acute changes in a client's condition that indicate instability to the supervising RN or provider.

Key Concept

Recognition and escalation of early shock indicators in postoperative clients
Question 352Question →

A practical nurse (PN) is caring for a client with osteoporosis who is scheduled to receive a weekly dose of oral risedronate. Which of the following actions must the PN take to safely administer this medication and reinforce client teaching? Select all that apply.

Select all that apply

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Answer: Confirm the client's identity using two distinct identifiers prior to providing the medication.; Instruct the client to swallow the tablet whole with a full glass of plain water upon waking.; Ensure the client maintains an upright seated or standing posture for at least 30 minutes after taking the dose.

Answer

The correct actions include confirming the client's identity with two identifiers, instructing the client to swallow the tablet whole with a full glass of plain water upon waking, and ensuring the client remains upright for at least 30 minutes.
Risedronate is a bisphosphonate that must be taken in the morning on an empty stomach with 6 to 8 ounces of plain water to ensure proper gastrointestinal absorption. The client must remain upright for a minimum of 30 minutes to prevent the tablet from causing severe esophageal irritation or ulceration. Verifying two distinct client identifiers is a universal safety standard for all medication administration.

Step-by-Step Solution

1
Identify the pharmacological classification of risedronate.
Risedronate is recognized as a bisphosphonate used for osteoporosis.
Understanding the drug class dictates the specific administration and monitoring rules.
2
Determine the required safety protocols for bisphosphonate administration.
The medication requires an empty stomach, plain water, and an upright posture post-administration.
These strict parameters prevent poor drug absorption and severe esophageal ulceration.
3
Evaluate the distractors against LPN scope of practice and medication rights.
Identify that crushing the medication, co-administering with calcium, and allowing a supine position violate safe administration principles.
Safe practice requires recognizing dangerous drug interactions and inappropriate delegation.

Key Concept

Bisphosphonate Administration Principles and Scope of Practice
Question 353Question →

An individual is recovering in the surgical unit 48 hours after undergoing a right below-the-knee amputation. As part of basic care and comfort, which of the following interventions should be implemented? Select all that apply.

Select all that apply

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Answer: Place the client in a prone position for 20 to 30 minutes multiple times a day.; Assist the client with active range-of-motion exercises for the left leg and upper extremities.; Examine the skin around the residual limb carefully for early signs of pressure or breakdown.

Answer

The appropriate interventions include placing the client in a prone position, assisting with range-of-motion exercises for the unaffected extremities, and examining the skin around the residual limb.
The correct options focus on maintaining mobility and preventing complications. Placing the client in a prone position several times a day stretches the flexor muscles and prevents hip flexion contractures. Assisting with active range-of-motion exercises on unaffected limbs maintains muscle strength essential for future ambulation and transfers. Examining the skin around the surgical site is a vital basic care measure to detect early signs of breakdown and maintain tissue integrity.

Step-by-Step Solution

1
Analyze the client's postoperative timeframe (48 hours) and procedure (below-the-knee amputation) to identify specific mobility and skin care needs.
Determined that the initial 24-hour acute phase has passed, shifting focus to contracture prevention and mobility preservation.
Postoperative guidelines change based on the time elapsed since surgery, particularly regarding elevation.
2
Evaluate the positioning options against the risk of flexion contractures.
Identified that prone positioning prevents contractures, while prolonged pillow elevation causes them.
Preventing contractures is crucial for ensuring the client can successfully use a prosthesis in the future.
3
Review the safety and comfort measures regarding confusion and skin integrity.
Recognized that skin inspection is mandatory, while immediate physical restraint violates safety protocols.
Nurses must prioritize least restrictive measures for confusion and proactively monitor for pressure injuries.
4
Select all options that promote safe recovery, maintain unaffected muscle strength, and adhere to appropriate positioning guidelines.
Selected the options for prone positioning, range-of-motion exercises, and skin inspection.
These actions collectively support the objective of basic care and comfort within the practical nurse's scope.

Key Concept

Postoperative Positioning and Mobility for Amputations
Question 354Question →

A practical nurse (PN) is assigned to a 78-year-old client who underwent an open reduction and internal fixation (ORIF) of a right femur fracture 24 hours ago. Which of the following actions by the PN demonstrate appropriate clinical judgment regarding the client's physiological adaptation? Select all that apply.

Select all that apply

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Answer: Report the sudden appearance of a petechial rash on the client's anterior chest to the registered nurse (RN).; Notify the RN if the client reports severe, progressive right leg pain that is unrelieved by the prescribed opioid analgesic.; Escalate a morning hemoglobin level of 7.1 g/dL (71 g/L) to the RN before attempting to ambulate the client.

Answer

The correct actions include reporting the petechial rash, notifying the RN about unrelenting severe pain, and escalating the critically low hemoglobin level.
The correct actions reflect sound clinical judgment by identifying classic signs of postoperative emergencies. A petechial rash is a hallmark of fat embolism syndrome. Severe pain unresponsive to opioid analgesics is a cardinal sign of acute compartment syndrome. A hemoglobin level of 7.1 g/dL indicates severe anemia and potential hemorrhage, making ambulation unsafe and requiring immediate RN notification for potential intervention.

Step-by-Step Solution

1
Analyze the client's postoperative risk profile.
The client is at high risk for complications such as fat embolism, compartment syndrome, and hemorrhage due to the femur fracture and recent surgery.
Identifying potential complications guides targeted data collection.
2
Evaluate each finding for signs of instability or systemic complications.
Petechiae, severe unrelenting pain, and a hemoglobin of 7.1 g/dL indicate critical physiological derangements.
The PN must differentiate between expected postoperative recovery and acute decompensation.
3
Apply the principles of prioritization.
Immediate escalation to the RN is required for findings involving airway/breathing (tachypnea), circulation (tachycardia, hypotension, low hemoglobin), and limb-threatening conditions (compartment syndrome).
Ensuring patient safety requires reporting critical findings before addressing secondary issues like routine incisional pain.

Key Concept

Recognition and prioritization of life-threatening postoperative complications following long bone fractures.
Question 355Question →

A practical nurse (PN) is assigned to collect a sterile urine specimen for culture and sensitivity from a client with a continuous indwelling urinary catheter. In what order should the PN perform the following actions to ensure specimen integrity and minimize the risk of infection? Arrange the steps in the correct chronological sequence.

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Answer

The correct sequence begins with clamping the tubing to collect fresh urine, followed by cleansing the port, aspirating the sample with a sterile syringe, transferring it to a sterile container, and finally unclamping the tubing to restore urinary flow.
Obtaining a sterile urine specimen from a closed drainage system requires a strict aseptic sequence to prevent catheter-associated urinary tract infections (CAUTIs) and ensure accurate laboratory results. The nurse must first clamp the tubing to allow fresh, uncontaminated urine to collect. Next, the port must be disinfected to prevent the introduction of pathogens. A sterile syringe is then used to safely aspirate the urine from the port. The sample is transferred to a sterile cup, and finally, the nurse must unclamp the tubing to prevent urinary retention and potential complications.

Step-by-Step Solution

1
Clamp the drainage tubing.
Fresh urine collects in the tubing.
Ensures the sample is recently produced rather than stagnant urine from the drainage bag.
2
Cleanse the collection port.
The external surface of the port is disinfected.
Prevents the introduction of bacteria into the closed catheter system.
3
Aspirate urine with a sterile syringe.
A sterile urine sample is obtained.
Maintains the closed drainage system integrity while safely extracting the specimen.
4
Transfer urine to a sterile container.
The sample is secured for transport.
Prevents contamination of the specimen en route to the laboratory.
5
Unclamp the drainage tubing.
Normal, continuous urine flow resumes.
Prevents dangerous bladder distention, discomfort, and potential renal complications.

Key Concept

Sterile Specimen Collection from a Closed Drainage System
Question 356Question →

A woman is resting in her hospital room a few hours after a right-sided modified radical mastectomy with axillary lymph node dissection. To promote optimal comfort and prevent complications, how should the practical nurse position the client's right arm?

Show answer & explanation

Answer: Elevated on a pillow so it rests above the level of the heart

Answer

The correct action is to keep the affected arm elevated on a pillow above the level of the heart.
Following a mastectomy with lymph node dissection, lymphatic drainage in the affected arm is significantly compromised. Elevating the arm on a pillow above the level of the heart uses gravity to promote lymphatic and venous return, thereby minimizing painful edema and enhancing client comfort.

Step-by-Step Solution

1
Identify the physiological impact of the specific surgical procedure.
The client underwent a right-sided mastectomy with axillary lymph node dissection, which disrupts normal lymphatic drainage pathways in the right arm.
Understanding the anatomical changes guides strategies for comfort and complication prevention.
2
Determine the mechanical goal for positioning the affected limb.
Gravity must be utilized to assist interstitial fluid and venous blood in returning from the right arm back toward the central circulation.
Preventing fluid accumulation (lymphedema) reduces tissue tension, minimizes pain, and promotes healing.
3
Select the positioning technique that best achieves this gravitational goal.
Elevating the entire right arm on a pillow so that it rests above the level of the client's heart is the most effective intervention.
This specific elevation angle creates a downward gradient for optimal fluid drainage.

Key Concept

Post-mastectomy lymphedema prevention through therapeutic positioning
Question 357Question →

A practical nurse (PN) is preparing to administer a scheduled dose of oral cephalexin to a client in an acute care facility. Upon entering the room, the PN observes that the client is not wearing an identification wristband. The client is alert, oriented, and states, 'I took the band off because it was scratching my arm.' Which action should the PN take?

Show answer & explanation

Answer: Obtain and apply a new identification wristband before administering the medication.

Answer

The nurse should obtain and apply a new identification wristband before administering the medication.
According to national patient safety standards, a nurse must verify a client's identity using two approved identifiers that match the client's physical identification band and the medication administration record. If the band is missing, it must be replaced before any medication is administered to ensure accurate verification and to comply with institutional barcode administration protocols.

Step-by-Step Solution

1
Assess the situation regarding patient identification requirements.
The client is missing their physical identification wristband.
Safe medication administration requires two patient identifiers verified against an official ID band and the medication administration record.
2
Determine the safest and most appropriate intervention to resolve the missing band.
A new identification band must be generated and applied to the client.
Facility policies require the ID band for barcode scanning and to prevent medication errors. Verbal confirmation alone is not a substitute for standard safety protocols.

Key Concept

Medication Rights Verification
Question 358Question →

A client with stable angina is prescribed a daily nitroglycerin transdermal patch. Place the following steps for applying the patch in the correct sequential order. (Move the steps into the correct order, starting with the first action.)

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Answer

The correct sequence is: put on gloves, remove the old patch, clean and dry a new site, label the new patch, and apply the new patch.
The correct sequence strictly adheres to safety protocols for transdermal medication administration. It begins with self-protection (gloves), prioritizes client safety by preventing overdose (removing the old patch), ensures optimal drug delivery (cleaning a new site), establishes accurate communication (labeling), and concludes with the actual administration (applying the patch).

Step-by-Step Solution

1
Put on clean gloves.
The nurse's hands are protected.
Nitroglycerin is readily absorbed through the skin and can cause adverse effects like headaches or hypotension in the nurse if handled with bare hands.
2
Remove the old patch and discard it properly.
The continuous delivery of the previous dose is stopped.
Failing to remove the old patch before applying a new one can lead to nitroglycerin toxicity and severe hypotension.
3
Cleanse and dry a new site.
A fresh, hairless area is prepared for the new medication.
Site rotation prevents skin breakdown, and a clean, dry surface is required for the adhesive to stick securely.
4
Label the new patch with date, time, and initials.
The patch is properly identified.
Labeling provides a clear timeline for medication administration and ensures the next nurse knows when the patch is due for removal.
5
Apply the new patch firmly to the skin.
The medication delivery process begins.
Pressing the patch firmly ensures it adheres fully and delivers the correct therapeutic dose.

Key Concept

Safe administration of transdermal medications requires protecting the nurse from exposure, preventing client toxicity by removing prior doses, and ensuring proper site rotation and documentation.
Question 359Question →

A practical nurse is preparing to transfer a client with right-sided weakness (hemiparesis) from the bed to a wheelchair. Arrange the following nursing actions in the correct sequence to ensure a safe transfer.

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Answer

The correct sequence for a safe transfer is: Position the wheelchair on the unaffected (left) side, lock the brakes on the bed and wheelchair, assist the client to sit on the edge of the bed, apply a transfer belt, and finally, instruct the client to bear weight on the strong leg and pivot.
A safe wheelchair transfer relies on proper preparation, biomechanics, and equipment safety. First, the environment must be prepared by placing the wheelchair on the client's unaffected (strong) side to maximize their participation. Next, all equipment brakes must be locked to prevent accidental movement. The client is then assisted to a sitting position to ensure hemodynamic stability and prevent orthostatic hypotension. Once the client is stable, a gait belt is applied to provide the nurse with a secure hold. Finally, the client uses their strong leg to pivot safely into the wheelchair.

Step-by-Step Solution

1
Position the wheelchair on the unaffected side.
The client will be able to reach for the chair with their strong arm.
Transferring toward the strong side ensures the client can support their own weight safely and maintain balance.
2
Lock the brakes on all equipment.
The bed and wheelchair are completely immobilized.
Unsecured equipment can roll backward during the transfer, causing a severe fall.
3
Assist the client to sit on the edge of the bed.
The client is in a seated position with feet on the floor.
Allows the client to regain equilibrium and prevents dizziness from orthostatic hypotension.
4
Apply the transfer belt.
The nurse has a secure grip on the client's waist.
Protects the client from falls and prevents the nurse from pulling on the client's weakened shoulder.
5
Pivot the client into the chair.
The client safely transitions from the bed to the wheelchair.
Using a pivot technique on the strong leg minimizes lifting for the nurse and promotes client independence.

Key Concept

Safe Client Transfer and Mobility Principles
Question 360Question →

A client who is three days postoperative following an abdominal laparotomy suddenly reports a "popping" sensation after a forceful cough. The practical nurse examines the surgical site and observes that the incision has separated and a loop of bowel is protruding. In which order should the nurse perform the following actions? (Arrange from first action to last)

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Answer

The correct sequence is to first stay with the client and call for help, then position them in low Fowler's with flexed knees, followed by covering the wound with sterile saline-moistened dressings, assessing vital signs, and finally documenting the event.
The correct sequence logically follows the principles of emergency nursing care: secure assistance without abandoning the client (call for help), immediately stabilize the mechanical threat using positioning (low Fowler's with bent knees), protect the compromised biological tissue (sterile moist dressings), monitor for systemic decompensation (vital signs), and conclude with accurate administrative recording (documentation).

Step-by-Step Solution

1
Recognize the medical emergency (wound evisceration).
Immediate identification that the client's internal organs are exposed and vulnerable to injury and infection.
Rapid recognition dictates that the client must not be left alone, necessitating a call for help as the absolute first action.
2
Implement immediate mechanical protection without requiring supplies.
The client is placed in low Fowler's position with knees flexed.
This specific position minimizes tension on the abdominal musculature, halting the further evisceration of the bowel.
3
Apply localized tissue protection once supplies are brought to the bedside.
The eviscerated bowel is covered with sterile, saline-moistened dressings.
Moist sterile dressings preserve tissue viability, prevent cellular necrosis, and form a barrier against environmental pathogens.
4
Assess systemic physiological adaptation and stability.
Vital signs are measured to establish a baseline during the acute event.
Monitoring blood pressure and pulse identifies the onset of hypovolemic shock or severe physiological distress.
5
Complete legal and medical record requirements.
The emergency event, interventions, and client status are documented.
Documentation must reflect chronological facts but is prioritized last to ensure direct client care is not delayed.

Key Concept

Prioritization of Nursing Interventions for Surgical Evisceration
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