Physiological Integrity

1313 questions

Question 621Question →

A school-aged client weighing 44 lb is prescribed acetaminophen 15 mg/kg orally every 4 hours for a temperature of 101.8°F (38.8°C). The pharmacy provides acetaminophen oral suspension with a concentration of 160 mg/5 mL. How many mL will the practical nurse administer per dose? Record the answer to the nearest tenth. Do not include units in answer.

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Answer: 9.4

Answer

9.4
To determine the correct dose, the practical nurse must first convert the child's weight to kilograms (44 lb ÷ 2.2 = 20 kg). Next, calculate the desired dose in milligrams (20 kg × 15 mg/kg = 300 mg). Finally, calculate the volume to administer using the supplied concentration (300 mg desired ÷ 160 mg available × 5 mL = 9.375 mL). Following standard rounding rules, 9.375 rounds to 9.4.

Step-by-Step Solution

1
Convert the client's weight from pounds (lb) to kilograms (kg).
44 lb ÷ 2.2 = 20 kg
The medication dosage is prescribed based on kilograms, so a weight conversion is required first.
2
Calculate the total required dose in milligrams (mg).
20 kg × 15 mg/kg = 300 mg
This establishes the total amount of medication needed for a single dose based on the client's body weight.
3
Calculate the required volume in milliliters (mL) using the formula (Desired / Have) × Volume.
(300 mg ÷ 160 mg) × 5 mL = 9.375 mL
This converts the required dose in mg to the physical volume needed based on the pharmacy's supplied concentration.
4
Round the final calculated volume to the nearest tenth.
9.375 mL rounds to 9.4 mL
The question explicitly requires the answer to be recorded to the nearest tenth.

Key Concept

Weight-based medication dosage calculation and fluid volume conversion
Question 622Question →

A young adult client is being monitored on the orthopedic unit several hours after the application of a rigid long-leg cast for a displaced tibial fracture. The client suddenly reports an intense, unrelenting ache in the calf that has worsened significantly despite the recent administration of prescribed intravenous analgesics. Recognizing a potential limb-threatening complication, which specific positioning intervention should the practical nurse implement while notifying the registered nurse?

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Answer: Ensure the affected extremity is supported and maintained resting completely flat at the level of the client's heart.

Answer

The nurse should ensure the affected extremity is supported and maintained completely flat at the level of the client's heart.
When a client exhibits signs of acute compartment syndrome (such as severe, unrelenting pain unresponsive to narcotics), the affected extremity must be positioned completely flat at the level of the heart. This neutral position optimizes arterial perfusion to the compromised tissues without increasing venous congestion. Elevating the limb would decrease arterial inflow, worsening ischemia, while a dependent position would increase swelling and interstitial pressure.

Step-by-Step Solution

1
Identify the clinical cues indicating a severe complication.
The client's unrelenting pain that is unresponsive to intravenous analgesics strongly suggests acute compartment syndrome.
Compartment syndrome causes extreme pressure within the muscle fascia, leading to rapid ischemia and severe pain that is disproportionate to the injury.
2
Determine the physiological impact of positioning on a limb with elevated compartment pressures.
Elevating the limb decreases arterial blood flow, while lowering the limb dependently increases venous congestion.
Both extremes compromise circulation and exacerbate tissue ischemia in this specific emergency.
3
Select the optimal position to maximize perfusion and minimize pressure.
The extremity must be kept at the level of the heart.
This neutral position optimizes arterial inflow to save the tissues without promoting excessive venous pooling.

Key Concept

Positioning Precautions for Suspected Compartment Syndrome
Question 623Question →

A practical nurse (PN) is preparing to administer prescribed ophthalmic drops to a client with glaucoma. In what order should the PN perform the following actions? Arrange the steps from first to last.

Drag items to arrange them in the correct order

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Answer

The correct sequence is: Verify identity and medication, position the client's head, expose the conjunctival sac, instill the drops, and apply pressure to the nasolacrimal duct.
Safe and effective administration of eye drops follows a specific anatomical and safety sequence. First, baseline safety checks must be completed. Second, the client is positioned to comfortably receive the medication. Third, the conjunctival sac is exposed to create a safe pouch. Fourth, the medication is instilled into this pouch to avoid direct corneal trauma. Finally, pressure is applied to the nasolacrimal duct (inner canthus) to prevent the medication from draining into the nasal mucosa and causing unintended systemic effects.

Step-by-Step Solution

1
Verify identity and medication.
The correct client is identified for the correct medication.
This is the fundamental first step of all medication administration procedures to prevent medication errors.
2
Instruct the client to tilt their head backward and look upward.
The eye is properly positioned for administration.
This position uses gravity to help keep the medication in the eye and moves the cornea away from the lower lid.
3
Pull down gently on the lower eyelid.
The conjunctival sac is exposed.
Creating a small pouch allows the medication to be held in the eye safely without striking the sensitive cornea.
4
Instill the drops into the lower conjunctival sac.
Medication is delivered to the eye.
Placing it in the sac ensures proper distribution across the eye surface when the client blinks.
5
Apply gentle pressure to the nasolacrimal duct.
The tear duct is temporarily blocked.
This prevents the medication from draining into the nasal mucosa and causing unintended systemic absorption.

Key Concept

Safe administration of ophthalmic medications requires verifying safety checks, correct client positioning, instillation into the conjunctival sac, and prevention of systemic absorption.
Question 624Question →

A practical nurse (PN) is assigned to feed a client who is recovering from a recent stroke that caused left-sided hemiparesis and severe dysphagia. The client also has a tracheostomy tube in place. The speech-language pathologist has cleared the client to begin a pureed diet. Which approach by the PN ensures the highest level of safety during this basic care activity?

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Answer: Elevate the head of the bed to 90 degrees, place the food on the right side of the client's mouth, and instruct the client to tuck the chin downward when swallowing.

Answer

The correct action is to elevate the head of the bed to 90 degrees, place the food on the right side of the mouth, and instruct the client to tuck their chin downward when swallowing.
A high-Fowler's position (90 degrees) safely utilizes gravity for swallowing. Placing food on the right (unaffected) side allows the client to effectively control the bolus and prevents dangerous pocketing on the paralyzed side. Finally, instructing the client to tuck their chin to their chest mechanically protects the airway by narrowing the laryngeal opening and directing food properly into the esophagus.

Step-by-Step Solution

1
Analyze the client's physical neurological deficits.
The client has left-sided hemiparesis, meaning the left side of the face and throat is weak. The right side is the strong, unaffected side.
Food must be placed on the strong side to prevent pocketing and allow for coordinated chewing and swallowing.
2
Evaluate the risk of aspiration.
Severe dysphagia and the presence of a tracheostomy tube put the client at an extremely high risk for aspiration.
Airway protection is the absolute clinical priority during oral intake for a stroke client.
3
Determine the optimal anatomical positioning and feeding technique.
A high-Fowler's position (90 degrees) combined with a chin-tuck maneuver is required.
The 90-degree angle uses gravity safely. The chin-tuck maneuver mechanically narrows the laryngeal opening (airway) and widens the esophageal opening, protecting the trachea from food entry.

Key Concept

Dysphagia Management and Airway Protection
Question 625Question →

A nursing assistant reports updated vital signs for a client who underwent a percutaneous liver biopsy 33 hours ago. The client's current blood pressure is 102/66102/66 mm Hg and heart rate is 112112 beats/min, compared to a pre-procedure baseline of 130/82130/82 mm Hg and 7878 beats/min. The client reports new, mild right shoulder pain. A review of the morning laboratory data shows a platelet count of 82,000/mm382,000/\text{mm}^3. Which action should the practical nurse take first?

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Answer: Examine the right upper quadrant dressing for saturation and gently palpate the abdomen for rigidity.

Answer

The correct action is to examine the right upper quadrant dressing for saturation and gently palpate the abdomen for rigidity.
The correct answer involves inspecting the biopsy site and abdomen. The client's trend of falling blood pressure and rising heart rate, combined with a low platelet count and right shoulder pain (referred pain from diaphragmatic irritation), strongly suggests internal hemorrhage following the liver biopsy. Within the practical nurse scope of practice, the immediate priority is to gather focused, direct assessment data regarding the potential complication before urgently notifying the registered nurse.

Step-by-Step Solution

1
Analyze the client's vital sign trends and presenting symptoms.
The client has a narrowing pulse pressure, hypotension, and tachycardia compared to baseline, alongside new right shoulder pain.
These are classic indicators of early hypovolemic shock and diaphragmatic irritation, strongly pointing to internal bleeding.
2
Correlate the clinical presentation with the morning laboratory results and recent procedure.
The client underwent a biopsy of a highly vascular organ (the liver) and has thrombocytopenia (low platelets).
A low platelet count significantly increases the risk of severe post-procedural hemorrhage, making the vital sign changes highly alarming.
3
Determine the priority nursing action within the practical nurse scope of practice.
The practical nurse must immediately perform a focused physical assessment of the surgical site and abdomen.
Gathering specific, direct clinical data about the potential bleeding site is required before urgently escalating the critical situation to the registered nurse.

Key Concept

Recognizing and prioritizing early signs of hemorrhagic shock and complications following invasive procedures.
Estimated Time:1m 30s
Question 626Question →

During hourly rounds on a medical-surgical unit, the practical nurse observes that an 81-year-old client being treated for bacterial pneumonia has become highly agitated and is picking at the bedsheets. The client's resting heart rate has increased to 112 beats per minute, and blood pressure has decreased to 102/62 mmHg from a morning baseline of 136/82 mmHg. Which action should the practical nurse take first?

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Answer: Obtain a peripheral oxygen saturation reading

Answer

Obtain a peripheral oxygen saturation reading
The correct answer prioritizes the assessment of oxygenation. In clients with respiratory conditions like pneumonia, sudden agitation or restlessness is often the earliest sign of hypoxia. The accompanying tachycardia and hypotension further suggest acute physiological decompensation. The practical nurse must immediately gather focused respiratory data to determine if the client is experiencing compromised breathing and circulation.

Step-by-Step Solution

1
Analyze the clinical cues presented by the client.
The client has a respiratory infection, new-onset agitation, tachycardia (112 bpm), and dropping blood pressure (102/62 mmHg).
Identifying the combination of neurological and cardiovascular changes helps recognize acute physiological decompensation.
2
Apply the ABC (Airway, Breathing, Circulation) priority framework.
The symptoms suggest impaired oxygenation (Breathing) or early shock (Circulation).
Sudden confusion or agitation in an older adult, especially with an underlying respiratory illness, is a classic sign of hypoxia and must be investigated immediately.
3
Determine the most appropriate immediate action within the practical nurse scope.
Obtaining an oxygen saturation reading rapidly assesses the client's respiratory status.
Measuring oxygen saturation directly evaluates the most likely life-threatening cause of the client's sudden status change.

Key Concept

Prioritization of Airway, Breathing, and Circulation in Acute Decompensation
Question 627Question →

A practical nurse (PN) is reviewing the medication administration record (MAR) for a client admitted with a blood pressure of 158/92 mmHg158/92\text{ mmHg} and a documented medical history of severe asthma. The provider has prescribed propranolol 40 mg40\text{ mg} orally every 12 hours and an albuterol metered-dose inhaler (MDI) as needed. Which action should the PN take first?

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Answer: Withhold the propranolol and notify the registered nurse (RN) to clarify the prescription with the provider.

Answer

The correct action is to withhold the propranolol and notify the registered nurse (RN) to clarify the prescription with the provider.
The correct answer addresses the critical contraindication of administering a non-selective beta-blocker (propranolol) to a client with severe asthma. Propranolol blocks beta-2 receptors in the lungs, which can trigger severe, potentially fatal bronchospasm. The practical nurse must recognize this risk, withhold the dose, and notify the RN or provider to advocate for a safer alternative, such as a cardioselective beta-blocker.

Step-by-Step Solution

1
Review the client's medical history and the newly prescribed medications.
The client has a history of severe asthma and is prescribed propranolol, a non-selective beta-blocker.
Identifying potential drug-disease interactions is a critical component of safe medication administration.
2
Analyze the pharmacological effects of the prescribed medication in relation to the client's underlying conditions.
Non-selective beta-blockers inhibit both beta-1 (cardiac) and beta-2 (pulmonary) receptors, which can induce dangerous bronchospasm in a client with asthma.
Understanding the mechanism of action helps predict severe adverse effects that compromise the airway.
3
Determine the appropriate nursing intervention within the practical nurse (PN) scope of practice.
The PN must withhold the unsafe medication and immediately escalate the concern to the RN or provider.
The PN is responsible for ensuring client safety by refusing to administer contraindicated medications and reporting to the supervising RN.

Key Concept

Medication Contraindications and Patient Safety
Estimated Time:1m 15s
Question 628Question →

A practical nurse (PN) is collecting data on a client who is receiving rapid intravenous (IV) fluid therapy for severe dehydration. Which of the following findings should alert the PN that the client is developing fluid volume overload? Select all that apply.

Select all that apply

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Answer: New onset of fine crackles auscultated in the bilateral lung bases; Jugular venous distention visible when the head of the bed is elevated; Increased respiratory rate of 28 breaths/min with shortness of breath

Answer

The correct findings indicating fluid volume overload are new onset of fine crackles in the lung bases, jugular venous distention, and an increased respiratory rate with shortness of breath.
Fluid volume overload occurs when intravenous fluids are administered faster than the cardiovascular and renal systems can process them. This excess volume backs up into the pulmonary circulation (causing crackles, tachypnea, and shortness of breath) and the systemic circulation (causing jugular venous distention). Recognizing these acute Airway, Breathing, and Circulation (ABC) cues is critical for immediate PN escalation.

Step-by-Step Solution

1
Analyze the client's current treatment and risk factors.
The client is receiving rapid IV fluids, placing them at high risk for circulatory overload if the body cannot process the volume quickly enough.
Identifying the intervention (rapid fluids) directly points to the potential complication (fluid volume excess).
2
Evaluate each finding for signs of excess fluid in the pulmonary or systemic circulation.
Crackles, rapid breathing, and jugular venous distention all demonstrate fluid backing up into the lungs and venous system.
These are the classic physiological adaptations indicating that the heart cannot pump the sudden excess volume effectively.
3
Differentiate between signs of improvement and signs of deterioration.
A normalizing heart rate (82 beats/min) is a sign of improvement from dehydration, and minor IV site pain is a local issue, neither of which indicates overload.
Recognizing expected therapeutic responses prevents the unnecessary escalation of normal findings.

Key Concept

Fluid Volume Overload Recognition
Question 629Question →

A practical nurse (PN) reviews the morning laboratory results for a client with heart failure who is scheduled to receive a daily dose of digoxin. The client's serum potassium level is 3.1 mEq/L3.1\text{ mEq/L}. During data collection, the client reports new-onset nausea and generalized weakness. Which action should the PN take first?

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Answer: Withhold the digoxin dose and immediately report the findings to the registered nurse (RN).

Answer

The PN must withhold the digoxin dose and immediately report the findings to the registered nurse (RN).
The correct answer is to withhold the medication and notify the RN. The client's potassium level is low (normal is 3.5 to 5.0 mEq/L), which strongly predisposes the client to digoxin toxicity. Combined with the clinical symptoms of nausea and weakness, these findings strongly suggest early toxicity. The safest action within the practical nurse's scope of practice is to hold the drug and escalate the data for further medical evaluation.

Step-by-Step Solution

1
Analyze the client's laboratory data.
The potassium level is 3.1 mEq/L, which indicates hypokalemia (normal is 3.5 to 5.0 mEq/L).
Identifying abnormal lab values is a crucial safety step before administering high-alert medications.
2
Correlate the lab findings and clinical symptoms with the scheduled medication.
Hypokalemia increases the risk for digoxin toxicity. Furthermore, nausea and generalized weakness are early clinical indicators of toxicity.
Recognizing the interaction between electrolyte imbalances and medication adverse effects is essential to prevent severe complications.
3
Determine the appropriate nursing action within the PN scope of practice.
The medication must be withheld and the critical findings escalated to the RN immediately.
The PN must ensure client safety by intervening when contraindications are present and reporting unstable conditions to the supervising RN.

Key Concept

Digoxin Toxicity and Hypokalemia
Question 630Question →

A client is recovering from a lumbar laminectomy. The nursing care plan requires turning the client every two hours. Which sequence of actions should the practical nurse implement to reposition this client safely from a supine to a lateral position?

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Answer

The nurse must first flatten the bed, prepare the client's body alignment by placing a pillow between the legs and crossing the arms, execute the turn as a single unit, and finally support the new lateral position with pillows.
Safe repositioning after spinal surgery requires the 'logrolling' technique. This procedural sequence ensures that the spine remains in strict alignment throughout the entire movement by flattening the bed, securing the extremities, turning the body as one solid unit, and providing postoperative support.

Step-by-Step Solution

1
Flatten the bed completely.
The client's spine rests perfectly horizontal.
Any elevation can cause twisting or bending of the spinal column during movement.
2
Place a pillow between the client's legs and have them cross their arms.
The hips, pelvis, and upper body are stabilized.
This maintains the alignment of the spine and prevents the extremities from causing rotation during the turn.
3
Roll the client as a single, straight unit.
The client is turned onto their side without twisting.
Moving the head, shoulders, and hips simultaneously (logrolling) prevents any torsion on the surgical site.
4
Position supportive pillows along the back and under the limbs.
The client rests securely and comfortably in the lateral position.
Proper support maintains spinal alignment and prevents the client from inadvertently rolling back.

Key Concept

Spinal alignment and logrolling technique
Question 631Question →

A young adult client arrives at the urgent care clinic experiencing an acute asthma exacerbation. The client is leaning forward, speaking in two-word phrases, and using accessory muscles to breathe. Audible wheezing is present. Which of the following actions should the practical nurse take immediately? (Select all that apply)

Select all that apply

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Answer: Position the client in a high-Fowler's or orthopneic position; Administer the prescribed inhaled albuterol treatment; Apply prescribed supplemental oxygen to maintain adequate saturation

Answer

The correct actions are to position the client in a high-Fowler's or orthopneic position, administer the prescribed inhaled albuterol treatment, and apply prescribed supplemental oxygen.
An acute asthma exacerbation is a medical emergency requiring rapid intervention to ensure airway patency and adequate oxygenation. Positioning the client upright facilitates maximal lung expansion. Administering a short-acting bronchodilator relieves acute bronchospasm, while supplemental oxygen treats immediate hypoxia.

Step-by-Step Solution

1
Recognize signs of an acute respiratory emergency.
The client's use of accessory muscles, tripod positioning, and inability to speak in full sentences indicate severe airway compromise.
Identifying acute physiological decompensation is the critical first step in prioritizing care.
2
Prioritize airway and breathing interventions.
Upright positioning, bronchodilators, and oxygen therapy are initiated immediately.
These rapid actions directly relieve airway constriction, improve oxygenation, and reduce the immediate threat to life.
3
Defer non-emergent or potentially harmful tasks.
Detailed history taking and oral fluid administration are avoided.
Non-emergent tasks delay life-saving care, and offering oral fluids presents a significant aspiration risk during severe dyspnea.

Key Concept

Acute Asthma Exacerbation Prioritization
Question 632Question →

A client is recovering on the surgical unit following a vaginal hysterectomy performed earlier in the day. During an afternoon assessment, the practical nurse (PN) notes that the client's heart rate has climbed from a baseline of 78 bpm to 112 bpm, while the blood pressure has decreased from 126/82 mm Hg to 102/60 mm Hg. A stat hemoglobin result from the laboratory is 7.4 g/dL (74 g/L). Which of the following actions should the PN take? Select all that apply.

Select all that apply

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Answer: Examine the perineal pads and the linens beneath the client for evidence of excessive bleeding.; Immediately communicate the changing physiological parameters and laboratory values to the registered nurse (RN).; Confirm the patency of the client's existing peripheral intravenous (IV) catheter.

Answer

The correct actions include examining the perineal pads and linens for bleeding, communicating the findings to the RN immediately, and confirming the patency of the client's peripheral IV catheter.
The client's increasing heart rate, decreasing blood pressure, and low hemoglobin of 7.4 g/dL (74 g/L) are classic signs of hypovolemic shock, likely due to post-operative hemorrhage. The appropriate nursing actions within the practical nurse scope involve immediately assessing for the source of the bleeding (perineal pads and linens), urgently escalating the critical findings to the registered nurse for provider notification, and ensuring that peripheral IV access is patent in anticipation of fluid or blood administration.

Step-by-Step Solution

1
Analyze the client's clinical data and identify trends.
The client has an increasing heart rate (78 to 112 bpm), a decreasing blood pressure (126/82 to 102/60 mm Hg), and a critically low hemoglobin of 7.4 g/dL.
Identifying changes from baseline is essential to detect acute post-operative complications.
2
Recognize the underlying clinical complication.
The combination of tachycardia, hypotension, and anemia in a post-surgical client strongly indicates hypovolemic shock secondary to hemorrhage.
Tachycardia is often the earliest compensatory sign of shock, followed by a drop in blood pressure.
3
Determine the appropriate PN interventions to mitigate risk.
The PN must assess for the source of bleeding, escalate the critical findings to the RN, and prepare for potential resuscitation by checking IV access.
These actions fall safely within the PN scope of practice and directly address the life-threatening risk without overstepping into independent medical intervention.

Key Concept

Post-Operative Hemorrhage and Hypovolemic Shock Recognition
Question 633Question →

A 4-year-old child who weighs 41.8 lb41.8\text{ lb} is brought to the pediatric clinic with acute otitis media. The healthcare provider prescribes cefdinir oral suspension 14 mg/kg/day14\text{ mg/kg/day} to be given in two equally divided doses. The dispensed medication bottle indicates that adding 38 mL38\text{ mL} of distilled water will yield a final reconstituted concentration of 250 mg/5 mL250\text{ mg}/5\text{ mL}. How many mL\text{mL} will the nurse administer for a single dose? (Record answer to the nearest tenth. Do not include units in answer.)

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Answer: 2.7

Answer

2.7
To determine the correct volume to administer, first convert the client's weight to kilograms (41.8 lb÷2.2=19 kg41.8\text{ lb} \div 2.2 = 19\text{ kg}). Next, find the total daily dose by multiplying the weight by the prescribed rate (19 kg×14 mg/kg=266 mg19\text{ kg} \times 14\text{ mg/kg} = 266\text{ mg}). Since this medication is given in two equally divided doses, divide by 2 to get the single dose amount (266 mg÷2=133 mg266\text{ mg} \div 2 = 133\text{ mg}). Finally, use the reconstituted concentration of 250 mg250\text{ mg} in 5 mL5\text{ mL} to find the volume to administer: (133 mg÷250 mg)×5 mL=2.66 mL(133\text{ mg} \div 250\text{ mg}) \times 5\text{ mL} = 2.66\text{ mL}. Rounding to the nearest tenth yields 2.7 mL2.7\text{ mL}. Note that the 38 mL38\text{ mL} of water mentioned is the diluent used to prepare the medication and is extraneous information designed to test critical reading skills.

Step-by-Step Solution

1
Convert weight to kilograms
19 kg19\text{ kg}
The medication dosage is prescribed based on the client's metric weight (mg/kg).
2
Determine total daily dose
266 mg/day266\text{ mg/day}
The prescription calls for 14 mg per kg per day.
3
Calculate the single dose
133 mg/dose133\text{ mg/dose}
The total daily medication is to be divided into two equal doses.
4
Calculate the required volume based on concentration
2.66 mL2.66\text{ mL}
The final reconstituted medication concentration is 250 mg per 5 mL.
5
Round to nearest tenth
2.7
Clinical rounding rules and the question instructions require rounding to the nearest tenth.

Key Concept

Pediatric weight-based dosage calculation and identifying relevant reconstitution data.
Question 634Question →

During a postoperative assessment of a client who had a subtotal thyroidectomy 6 hours ago, the practical nurse notes that the client's heart rate has increased from a baseline of 82 bpm to 114 bpm, and blood pressure has decreased from 124/76 mmHg to 102/58 mmHg. The client appears restless and states, "My neck dressing feels a bit tighter than before." Which of the following is the priority nursing action?

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Answer: Inspect the back of the client's neck for pooling blood and immediately notify the registered nurse.

Answer

The priority action is to check the dependent area behind the client's neck for bleeding and escalate the critical findings to the registered nurse without delay.
Following a thyroidectomy, a tightening dressing combined with restlessness, an increasing heart rate, and a decreasing blood pressure strongly suggest hemorrhage. Blood often pools dependently at the back of the neck due to gravity. The practical nurse must immediately assess this area and notify the registered nurse to prevent hypovolemic shock and acute airway obstruction.

Step-by-Step Solution

1
Analyze the client's postoperative clinical cues.
The client presents with a new onset of tachycardia, mild hypotension, restlessness, and a sensation of a tightening dressing.
Identifying these specific changes establishes a baseline for recognizing acute physiological decompensation.
2
Correlate the cues with potential surgical complications.
These findings collectively indicate a high probability of active hemorrhage and potential airway compression.
After a thyroidectomy, bleeding can pool dependently behind the neck and compress the trachea, creating a life-threatening emergency.
3
Determine the priority nursing action within the practical nurse scope.
The nurse must immediately inspect the dependent area for bleeding and report the findings to the registered nurse.
Prompt escalation ensures the client receives necessary emergency medical interventions to stabilize circulation and secure the airway.

Key Concept

Early recognition of postoperative hemorrhage and airway compromise
Question 635Question →

An adult client is prescribed an intramuscular injection of iron dextran. To minimize tissue irritation and prevent medication leakage into subcutaneous layers, the practical nurse administers the medication using the Z-track technique. Arrange the steps of this procedure in the correct chronological sequence.

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Answer

The correct sequence is to first displace the skin laterally, then insert the needle at a 90-degree angle, followed by injecting the medication slowly. After injecting, wait 10 seconds before finally withdrawing the needle and releasing the skin simultaneously.
The Z-track method is designed specifically to prevent medication leakage and tissue irritation. Displacing the skin first creates an offset track. Inserting the needle and injecting slowly ensures proper muscle delivery. Waiting 10 seconds allows the medication to disperse so it does not follow the needle out. Finally, releasing the skin exactly as the needle is withdrawn creates a zigzag tissue seal that traps the medication in the muscle.

Step-by-Step Solution

1
Displace the skin laterally.
Creates an offset, zigzag path through the underlying tissue layers.
This is the foundational step of the Z-track method to prevent medication leakage.
2
Dart the needle into the muscle.
Needle enters the deep muscle tissue while the skin is held displaced.
Proper placement ensures intramuscular, rather than subcutaneous, delivery.
3
Inject the medication slowly.
Medication is deposited deep into the muscle.
Allows muscle fibers to accommodate the volume, reducing pain and tissue trauma.
4
Wait for 10 seconds before removing the needle.
Medication begins to disperse into the surrounding muscle tissue.
Prevents the medication from being forced back up the track upon immediate needle removal.
5
Withdraw the needle and release the skin simultaneously.
Tissue planes slide back into their original, unaligned positions.
Seals the needle track, securely trapping the medication inside the deep muscle layer.

Key Concept

Safe administration of intramuscular injections using the Z-track technique
Question 636Question →

A practical nurse is caring for an older adult client who is 48 hours post-operative following a left above-the-knee amputation. The client appears restless and reports a pulling and cramping sensation in the residual limb. Which intervention should the nurse implement to address this discomfort and prevent a common musculoskeletal complication?

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Answer: Assist the client into a prone position for 20 to 30 minutes several times a day.

Answer

Assist the client into a prone position for 20 to 30 minutes several times a day.
Following an above-the-knee amputation, clients are at a exceptionally high risk for developing hip flexion contractures, which can permanently prevent the use of a prosthetic limb. Placing the client in a prone position for 20 to 30 minutes, three to four times a day, actively stretches the hip flexor muscles, reduces cramping sensations, and maintains proper anatomical alignment.

Step-by-Step Solution

1
Analyze the client's postoperative time frame and clinical presentation.
The client is 48 hours post-amputation, experiencing cramping, and appearing restless. This indicates muscle spasms and a high risk for developing joint contractures.
Identifying the physiological phase of recovery (beyond the initial 24 hours) dictates the correct positional therapy required to prevent long-term mobility issues.
2
Evaluate the mechanism of the potential musculoskeletal complication.
Following an above-the-knee amputation, the flexor muscles of the hip tend to contract and shorten, pulling the residual limb upward.
Hip flexion contractures severely impair a client's ability to maintain an upright posture and be successfully fitted for a prosthetic limb.
3
Select the appropriate evidence-based positioning intervention.
Placing the client in a prone (face-down) position actively stretches the hip flexor muscles, thereby preventing contractures.
Prone positioning is a standard basic care measure implemented after the first 24 hours of an amputation to maintain joint mobility and relieve flexor cramping.

Key Concept

Post-Amputation Positioning and Contracture Prevention
Question 637Question →

A client with type 1 diabetes mellitus begins to experience diaphoresis, palpitations, and hand tremors. The client is alert and oriented. In what order should the practical nurse implement the following interventions? Arrange the actions in the correct sequence from first to last.

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Answer

The correct sequence is to first assess the blood glucose, treat with a fast-acting carbohydrate, recheck in 15 minutes, and finally provide a stabilizing snack.
When a conscious client exhibits signs of hypoglycemia, the practical nurse should follow the 'Rule of 15'. The sequence begins with assessment (checking blood glucose), followed by immediate treatment (giving a fast-acting carbohydrate), evaluation of the intervention (rechecking the glucose in 15 minutes), and long-term stabilization (providing a complex carbohydrate and protein snack).

Step-by-Step Solution

1
Obtain a fingerstick blood glucose reading.
The nurse confirms the presence of hypoglycemia.
Assessment is always the priority when a client exhibits new symptoms, ensuring the correct problem is treated.
2
Administer 4 ounces of a fast-acting carbohydrate.
The client's blood sugar begins to rise rapidly.
Simple carbohydrates are quickly absorbed to resolve the acute hypoglycemic state.
3
Recheck the blood glucose level after 15 minutes.
The nurse verifies if the initial treatment was effective.
Continuous evaluation is necessary to determine if further simple carbohydrates are needed, following the standard 'Rule of 15'.
4
Provide a snack containing a complex carbohydrate and protein.
The client's blood sugar remains stable over time.
Complex carbohydrates and proteins digest slowly, preventing a secondary crash in blood sugar.

Key Concept

Management of Acute Hypoglycemia (Rule of 15)
Question 638Question →

During morning rounds on the orthopedic unit, a licensed practical nurse is assisting a client who recently underwent a left total hip arthroplasty. When performing hygiene and repositioning tasks, which action should the nurse take?

Show answer & explanation

Answer: Secure an abduction wedge between the client's lower extremities before turning.

Answer

Secure an abduction wedge between the client's lower extremities before turning.
Following a total hip arthroplasty, the client is at a high risk for hip dislocation if the joint is adducted, internally rotated, or flexed beyond 90 degrees. Securing an abduction wedge or pillow between the client's legs prior to turning ensures that the legs remain apart (abducted), thereby maintaining proper anatomical alignment and protecting the surgical site during basic care routines.

Step-by-Step Solution

1
Identify the client's surgical procedure and associated risks.
The client had a left total hip arthroplasty, which carries a high risk for joint dislocation if positioned improperly.
Different surgeries require specific postoperative precautions during basic care to prevent injury.
2
Determine the contraindicated movements for a total hip arthroplasty.
Movements to avoid include hip flexion greater than 90 degrees, adduction past the midline, and internal rotation of the affected extremity.
These specific movements place excessive stress on the surgical joint capsule and can pop the prosthesis out of place.
3
Evaluate the nursing actions in the options against these precautions.
Using an abduction wedge is the only action that aligns with safety protocols by actively preventing adduction.
Maintaining proper joint alignment is an essential component of basic care and repositioning.

Key Concept

Postoperative Positioning and Precautions for Total Hip Arthroplasty
Question 639Question →

While conducting hourly rounds, a practical nurse (PN) observes that a client with a history of asthma is suddenly leaning forward, visibly distressed, and wheezing audibly. Arrange the following nursing actions in the correct priority sequence from first to last.

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Answer

The correct sequence prioritizes immediate airway positioning, followed by oxygenation, pharmacological intervention, and finally, reassessment of the client's respiratory status.
In an acute respiratory distress scenario, nursing actions must follow the ABC (Airway, Breathing, Circulation) framework and the nursing process. Assisting the client into an upright position (Airway) is the most immediate action that can be performed in seconds to facilitate lung expansion. Applying oxygen (Breathing) directly addresses hypoxemia. Administering a bronchodilator treats the underlying condition, and finally, reassessment (Evaluation) determines if the interventions were successful.

Step-by-Step Solution

1
Assist the client into a high-Fowler's position.
Lung expansion is mechanically maximized.
This is the fastest, most immediate action to ease respiratory effort and support the airway.
2
Apply supplemental oxygen as prescribed.
Hypoxemia is addressed.
Meets the immediate physiological demand for oxygen (Breathing) during distress.
3
Administer the prescribed short-acting bronchodilator via nebulizer.
Bronchial smooth muscles relax.
Treats the acute bronchospasm that is causing the wheezing and distress.
4
Auscultate lung sounds and measure oxygen saturation.
Post-intervention baseline is established.
Evaluates the client's physiological adaptation and response to the applied interventions.

Key Concept

Prioritization of Acute Respiratory Interventions (Airway, Breathing, Interventions, Evaluation)
Question 640Question →

A practical nurse (PN) is caring for a client who is receiving intravenous fluids via a central venous catheter. The client suddenly grasps their chest, gasps for air, and becomes rapidly cyanotic. Suspecting an air embolism, arrange the following emergency risk reduction actions in the priority order the PN should implement them.

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Answer

The correct sequence is to first clamp the catheter, then place the client in a left lateral Trendelenburg position, administer high-flow oxygen, activate the rapid response team, and finally obtain vital signs while remaining with the client.
When a central venous air embolism is suspected, the immediate focus is on stopping the entry of air and preventing it from blocking pulmonary circulation. Clamping the line stops the source. The left lateral Trendelenburg position uses gravity to trap air in the right ventricle, preventing it from entering the pulmonary artery. Oxygen treats hypoxia and shrinks the bubble. Calling for advanced help and continuous monitoring follow these immediate life-saving physical interventions.

Step-by-Step Solution

1
Identify the suspected air embolism and clamp the central venous catheter immediately.
The entry point for the air is closed off.
This is the most critical initial step to prevent additional air from entering the bloodstream and worsening the condition.
2
Place the client in a left lateral Trendelenburg position.
The air bubble is trapped in the right ventricle.
This specific position uses gravity to keep the air away from the pulmonary valve, preventing a pulmonary embolism.
3
Administer high-flow oxygen.
The client receives maximum oxygenation.
Oxygen treats the immediate respiratory distress and helps dissolve the nitrogen in the air bubble.
4
Activate the rapid response team and notify the RN.
Advanced help is dispatched to the client's room.
The client requires advanced life support and potentially transfer to the intensive care unit.
5
Obtain a complete set of vital signs.
Baseline data during the event is established.
This information is vital for the rapid response team to determine the next medical interventions.

Key Concept

Emergency Management of a Central Venous Air Embolism
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