Physiological Integrity

1313 questions

All types1,313 Multiple choice672 Multiple select289 Numeric68 Ordering284

An older adult client with chronic obstructive pulmonary disease (COPD) and hypertension is admitted for a severe respiratory exacerbation. Current assessment findings include a blood pressure of 158/92 mmHg, a heart rate of 112 beats/min, a respiratory rate of 28 breaths/min, and an oxygen saturation of 88% on room air. The provider's orders include a one-time dose of intravenous (IV) push methylprednisolone, a stat albuterol nebulizer treatment, and a scheduled dose of oral amlodipine. Which of the following actions best demonstrates the appropriate role of the practical nurse (PN) in managing this client's pharmacological therapies?

Administer the oral amlodipine immediately to address the elevated blood pressure, relying solely on the client's verbal confirmation of their first name to expedite emergency care.

Withhold the albuterol nebulizer treatment due to the client's presenting heart rate of 112 beats/min and promptly document the rationale in the medical record.

Initiate the albuterol nebulizer treatment, administer the oral amlodipine, and monitor the client's respiratory status while the registered nurse administers the intravenous push methylprednisolone.

Prepare and administer the intravenous push methylprednisolone slowly over 3 to 5 minutes after confirming the client's identity using two distinct identifiers.

Show answer & explanation

Answer: Initiate the albuterol nebulizer treatment, administer the oral amlodipine, and monitor the client's respiratory status while the registered nurse administers the intravenous push methylprednisolone.

Answer

The practical nurse should safely administer the oral and inhaled medications, but must defer the administration of the intravenous push medication to the registered nurse.

The correct action demonstrates strict adherence to the practical nurse's legal scope of practice while appropriately prioritizing care. Administering oral and inhaled medications is safely within the practical nurse scope. However, intravenous push medications require the advanced assessment skills of a registered nurse. By initiating the respiratory treatment promptly, the practical nurse addresses the client's most critical airway needs while legally and safely delegating the intravenous medication.

Step-by-Step Solution

Analyze the client's clinical presentation and the prescribed pharmacological interventions.

The client is in a respiratory crisis (hypoxia, tachypnea) requiring immediate intervention with a bronchodilator (albuterol) and a corticosteroid (methylprednisolone), alongside management of hypertension (amlodipine).

Understanding the clinical priorities ensures that the most critical needs (Airway and Breathing) are addressed first.

Evaluate the practical nurse scope of practice regarding the prescribed medication routes.

Oral (amlodipine) and inhaled (albuterol) medication administration are within the practical nurse's scope of practice. However, intravenous push administration (methylprednisolone) is restricted and falls under the registered nurse's scope of practice.

Adhering strictly to the legal scope of practice is mandatory for client safety and professional licensure compliance.

Determine the safest and most effective plan for pharmacological management.

The practical nurse should initiate the albuterol nebulizer to address the immediate airway compromise, give the oral amlodipine, and collaborate with the registered nurse to administer the intravenous push methylprednisolone.

This collaborative approach ensures all medications are administered promptly while maintaining strict adherence to safety protocols and scope of practice limitations.

Key Concept

Practical Nurse Scope of Practice and Prioritization in Pharmacological Therapies

Question 722Question →

A toddler weighing $35.2$ lb is prescribed oral acetaminophen $15$ mg/kg every $4$ hours as needed for fever. The medication available is an oral suspension with a concentration of $160$ mg/ $5$ mL. How many milliliters should the practical nurse administer for one dose? (Record answer to the nearest tenth. Do not include units in answer.)

Show answer & explanation

Answer: 7.5

Answer

7.5

The calculation requires three clinical math steps: first converting the client's weight to kilograms (

35.2 \div 2.2 = 16

kg), determining the weight-based dose (

16 \times 15 = 240

mg), and then calculating the liquid volume using the available concentration of

160

mg per

5

mL (

\frac{240}{160} \times 5 = 7.5

mL). The correct final amount to administer is

7.5

mL.

Step-by-Step Solution

Convert the child's weight from pounds (lb) to kilograms (kg).

16

The medication dosage is prescribed in mg/kg, requiring the client's weight to be converted using the factor

1

kg =

2.2

lb (

35.2 \div 2.2 = 16

Calculate the total required dose in milligrams (mg).

240

Multiply the weight in kilograms by the prescribed dosage amount (

16 \text{ kg} \times 15 \text{ mg/kg} = 240 \text{ mg}

Calculate the volume of liquid to administer in milliliters (mL).

7.5

Use the formula: (Desired / Have) × Quantity. Here, (

\frac{240 \text{ mg}}{160 \text{ mg}}

) ×

5 \text{ mL} = 1.5 \times 5 \text{ mL} = 7.5 \text{ mL}

Key Concept

Weight-based pediatric dosage calculation and liquid medication volume computation

Question 723Question →

The practical nurse is preparing to draw up a prescribed medication from a glass ampule. Arrange the following steps in the correct chronological order.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence is: tap the top of the ampule, place a gauze pad around the neck, snap the neck away from the body, attach a filter needle to withdraw the medication, and finally replace the filter needle with an administration needle.

Safe medication preparation from an ampule requires a specific sequence to prevent injury to the nurse and the client. First, fluid must be cleared from the neck to ensure an accurate dose. Second, the nurse protects their hands with a pad or swab. Third, the ampule is snapped safely away from the body. Fourth, a filter needle is used to draw up the medication, ensuring no glass particles enter the syringe. Finally, the filter needle is replaced with a regular needle for safe administration.

Step-by-Step Solution

Identify the first action required before opening the ampule.

Tap the top of the ampule lightly.

Medication often gets trapped in the top of the ampule and must be moved to the bottom chamber to ensure the full dose is available.

Determine the safety measures needed to open the glass ampule.

Place a gauze pad around the neck and snap it away from the body.

The gauze pad protects the nurse's fingers, and snapping away from the body prevents glass shards from flying toward the face.

Select the correct equipment to withdraw the medication.

Attach a filter needle and withdraw the medication.

Breaking a glass ampule can introduce microscopic glass shards into the fluid. A filter needle traps these particles so they do not enter the syringe.

Identify the final preparation step before giving the injection.

Replace the filter needle with an administration needle.

Filter needles are not designed for tissue injection and must be removed prior to administering the medication to the client.

Key Concept

Safe Preparation of Medication from an Ampule

Question 724Question →

A practical nurse is assisting a client with left-sided hemiparesis to transfer from the bed to a wheelchair. In what order should the nurse perform the following actions? Arrange the steps from first to last.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

First, position the wheelchair on the right side. Second, lock the wheels. Third, assist the client to sit on the edge of the bed. Fourth, secure the transfer belt. Finally, pivot the client into the wheelchair.

Safe transfer protocols require organizing the environment first (placing the chair on the strong side), securing the equipment (locking wheels), moving the client to a stable intermediate position (dangling), applying safety devices (transfer belt), and finally executing the movement leading with the strong side.

Step-by-Step Solution

Identify the client's physical limitations and determine equipment placement.

The client has left-sided weakness, meaning the right side is strong. The wheelchair is placed on the strong side.

Transfers should always lead with the client's strong side to maximize stability and minimize fall risk.

Secure the transfer environment.

Both the bed and the wheelchair wheels are locked.

Equipment must be immobilized before the client shifts their weight to prevent the bed or chair from moving.

Determine the physical sequence for moving the client safely.

Sit the client on the bed, apply the transfer belt, and then pivot to the chair.

The client must be seated safely before the safety belt can be properly applied, and the belt must be secured before attempting to bear weight or pivot.

Key Concept

Safe client transfer techniques and mobility assistance

Question 725Question →

While conducting a routine postoperative assessment, a practical nurse reviews the status of an adult client who underwent an open cholecystectomy 4 hours ago. The client has a closed-wound drainage system that contains 30 mL of serosanguineous fluid. The client states, "My stomach hurts, and I feel a bit dizzy when I turn over."

A comparison of the client's vital signs reveals the following:

Parameter	Preoperative Baseline	Current Assessment
Blood Pressure	134/80 mm Hg	102/60 mm Hg
Heart Rate	82 bpm	118 bpm
Respirations	16/min	20/min

Based on these findings, what is the priority action for the nurse?

Administer the prescribed PRN analgesic for the reported abdominal pain

Assist the client to an upright sitting position to safely evaluate the dizziness

Notify the registered nurse immediately regarding the assessment findings

Empty the drainage system and document the output in the electronic health record

Show answer & explanation

Answer: Notify the registered nurse immediately regarding the assessment findings

Answer

The correct action is to notify the registered nurse immediately regarding the assessment findings.

The correct answer identifies the need for immediate escalation. The client's significant increase in heart rate and decrease in blood pressure, combined with dizziness, are classic early indicators of hypovolemic shock, likely due to internal hemorrhage. Even though the external drain output is minimal, bleeding may be accumulating internally. The practical nurse must immediately notify the registered nurse so that prompt medical intervention can be initiated.

Step-by-Step Solution

Analyze the client's vital signs by comparing the current readings to the preoperative baselines.

The heart rate has increased significantly from 82 to 118 bpm, and the blood pressure has dropped from 134/80 to 102/60 mm Hg.

Identifying trends is essential for recognizing early postoperative complications.

Evaluate the client's subjective symptoms in conjunction with the objective data.

The client reports abdominal pain and dizziness when moving.

Dizziness paired with hypotension and tachycardia strongly suggests decreased cerebral perfusion due to hypovolemia.

Determine the most appropriate nursing action based on the practical nurse scope of practice and the severity of the findings.

The findings indicate potential internal hemorrhage and shock, which requires immediate escalation.

The practical nurse must promptly report subtle signs of shock to the registered nurse, as the client requires immediate medical intervention that exceeds the practical nurse's scope.

Key Concept

Early recognition of hypovolemic shock and prioritization of escalation.

Question 726Question →

A $68$ -year-old client is admitted to the medical-surgical unit with a deep vein thrombosis and is receiving a continuous intravenous heparin infusion. The practical nurse is reviewing the morning laboratory results and performing a routine assessment. The client's activated partial thromboplastin time (aPTT) is $118$ seconds (control $32$ seconds). During the assessment, the client reports a new, persistent headache. Vital signs are heart rate $112$ bpm, blood pressure $94/58$ mm Hg (baseline $132/78$ mm Hg), and respirations $20$ /min. What is the most appropriate next action for the practical nurse to take?

Instruct the client to remain strictly in bed and urgently communicate the clinical findings to the supervising registered nurse.

Decrease the heparin infusion rate according to the facility weight-based nomogram and recheck the aPTT in six hours.

Offer the client a prescribed as-needed analgesic for the headache and dim the lights in the room to promote comfort.

Record the vital signs in the electronic health record and plan to reassess the blood pressure in one hour.

Show answer & explanation

Answer: Instruct the client to remain strictly in bed and urgently communicate the clinical findings to the supervising registered nurse.

Answer

Instruct the client to remain strictly in bed and urgently communicate the clinical findings to the supervising registered nurse.

The correct answer directly addresses the immediate risk of severe internal hemorrhage while remaining within the appropriate scope of practice. An aPTT of

118

seconds is critically elevated. Combined with a new headache, tachycardia, and a precipitous drop in blood pressure, these findings strongly suggest active internal bleeding (such as intracranial or gastrointestinal hemorrhage). The practical nurse must prioritize client safety by instituting bed rest and immediately escalating these critical findings to the registered nurse for urgent medical intervention.

Step-by-Step Solution

Evaluate the aPTT laboratory result against the provided normal control value.

The aPTT of

118

seconds is recognized as critically high, well beyond the standard therapeutic range of

1.5

2.5

times the control (

48

80

seconds).

Identifying critical values is the first step in recognizing severe physiological risk, specifically spontaneous hemorrhage.

Correlate the critical coagulation result with the client's vital signs and subjective symptoms.

The combination of a critically high aPTT, a new persistent headache, tachycardia (

112

bpm), and a significant drop in blood pressure (

94/58

mm Hg) strongly points to active internal bleeding, potentially intracranial.

Synthesizing multiple clinical data points allows for the recognition of acute clinical deterioration and shock.

Determine the safest and most appropriate intervention within the practical nurse scope of practice.

The nurse identifies that protecting the client from falls (strict bed rest) and immediately escalating the findings to the registered nurse is required.

Practical nurses must independently recognize life-threatening complications but must collaborate with or delegate to the RN for the management of continuous high-risk infusions and complex medical interventions.

Key Concept

Early recognition of internal hemorrhage and escalation within the practical nursing scope of practice.

Question 727Question →

A $65$ -year-old client is admitted to the medical unit with an exacerbation of chronic obstructive pulmonary disease (COPD). The client's morning vital signs are blood pressure $138/82\text{ mm Hg}$ , heart rate $88\text{ beats/min}$ , and respiratory rate $20\text{ breaths/min}$ . The practical nurse is reviewing the client's medication orders and preparing for administration. Which action by the practical nurse demonstrates safe and appropriate pharmacological practice?

Instructing the client to rinse their mouth with water and spit after administering a scheduled dose of inhaled fluticasone.

Administering a scheduled live-attenuated influenza vaccine to the client while they are actively receiving high-dose systemic corticosteroid therapy.

Administering

10\text{ mL}

of an oral antibiotic suspension when the prescribed dose is

250\text{ mg}

and the supplied concentration is

250\text{ mg}/5\text{ mL}

Bypassing the verification of the client's identification band before giving medications because the nurse has cared for the client for three consecutive days.

Show answer & explanation

Answer: Instructing the client to rinse their mouth with water and spit after administering a scheduled dose of inhaled fluticasone.

Answer

The correct action is instructing the client to rinse their mouth with water and spit after administering a scheduled dose of inhaled fluticasone.

The correct action is instructing the client to rinse their mouth and spit after using an inhaled corticosteroid like fluticasone. This is a crucial safety measure to prevent localized fungal infections, such as oral candidiasis, and reinforcing this teaching is entirely appropriate and expected within the practical nurse's scope of practice.

Step-by-Step Solution

Analyze the correct role of the practical nurse regarding the administration of inhaled corticosteroids.

Inhaled fluticasone is a corticosteroid; rinsing the mouth after administration prevents localized fungal infections like oral thrush.

Reinforcing medication education and preventing adverse effects are key responsibilities within the practical nurse's scope of practice.

Evaluate the action regarding the live-attenuated influenza vaccine.

This action is unsafe and contraindicated.

Live vaccines can cause active infection in clients who are immunocompromised due to high-dose systemic corticosteroids.

Calculate the correct dosage for the oral antibiotic suspension.

The correct dose is

5\text{ mL}

Using the formula: (Desired

250\text{ mg}

/ Have

250\text{ mg}

) × Volume

5\text{ mL}

5\text{ mL}

. Administering

10\text{ mL}

would be a double dose.

Evaluate the client identification process.

This action violates medication safety protocols.

Nurses must always use two identifiers (e.g., name and date of birth) and scan the barcode before every administration to ensure client safety.

Key Concept

Safe Medication Administration and Pharmacological Practice

Question 728Question →

A practical nurse is reviewing the morning laboratory results for an adult client receiving chemotherapy. Which finding indicates a significant risk for complications and must be reported to the registered nurse immediately?

Platelet count of

30,000/\text{mm}^3

White blood cell (WBC) count of

6,500/\text{mm}^3

Serum potassium level of

4.2\text{ mEq/L}

Hemoglobin level of

11.0\text{ g/dL}

Show answer & explanation

Answer: Platelet count of $30,000/\text{mm}^3$

Answer

The practical nurse must immediately report the platelet count of

30,000/\text{mm}^3

A platelet count of

30,000/\text{mm}^3

is significantly below the normal adult range of

150,000

400,000/\text{mm}^3

. This condition, known as severe thrombocytopenia, places the client at imminent risk for spontaneous, potentially life-threatening hemorrhage. The practical nurse must immediately report this critical finding to the registered nurse so that strict bleeding precautions and possible platelet transfusions can be initiated.

Step-by-Step Solution

Review the provided laboratory values and compare each result against normal adult reference ranges.

The WBC and potassium levels are normal. The hemoglobin is slightly low, while the platelet count is critically low.

Identifying which values are outside of normal limits is the essential first step in risk reduction and prioritization.

Analyze the clinical significance of the abnormal values in the context of a client receiving chemotherapy.

A platelet count of

30,000/\text{mm}^3

represents severe thrombocytopenia, creating an immediate risk for spontaneous internal hemorrhage.

Chemotherapy induces bone marrow suppression. The nurse must determine which suppressed cell line poses the most acute threat to the client's life.

Select the finding that requires the most urgent clinical intervention and escalation.

The severely low platelet count is the priority and must be communicated to the registered nurse without delay.

Prompt escalation ensures timely medical intervention, such as initiating strict bleeding precautions or preparing a platelet transfusion.

Key Concept

Recognizing and prioritizing critical laboratory values to reduce client risk

Question 729Question →

A practical nurse is providing care for a client who is on strict bed rest following a left femoral cardiac catheterization. The client requires assistance with hygiene, elimination, and comfort. Which of the following basic care interventions should the nurse implement? (Select all that apply)

Select all that apply

Assist the client to use a fracture bedpan while keeping the left leg completely straight.

Raise the head of the bed to a high-Fowler's position while the client is eating a meal.

Provide a complete bed bath and assist with oral hygiene while keeping the head of the bed flat.

Turn the client onto the left side by bending the left knee to wash the client's back.

Delegate the initial observation of the femoral puncture site for bleeding to the unlicensed assistive personnel (UAP).

Support the client's lower back with a small rolled towel to reduce discomfort.

Show answer & explanation

Answer: Assist the client to use a fracture bedpan while keeping the left leg completely straight.; Provide a complete bed bath and assist with oral hygiene while keeping the head of the bed flat.; Support the client's lower back with a small rolled towel to reduce discomfort.

Answer

The nurse should assist the client to use a fracture bedpan while keeping the left leg straight, provide hygiene care while keeping the bed flat, and support the lower back with a small rolled towel.

Following a femoral approach cardiac catheterization, the client must remain supine or in a low-Fowler's position (head elevated 30 degrees or less) with the affected leg completely straight to prevent bleeding. Assisting with a fracture bedpan, providing hygiene while flat, and using a lumbar support towel all safely meet the client's basic care and comfort needs while adhering to these critical positioning restrictions.

Step-by-Step Solution

Identify the procedural constraints for a femoral cardiac catheterization.

The client must remain on bed rest with the affected leg (left) completely straight and the head of the bed elevated no more than 30 degrees.

Flexing the hip or knee on the affected side increases the risk of arterial bleeding and hematoma.

Evaluate each intervention against the positioning constraints.

Interventions that maintain a straight leg and flat or low-Fowler's position are safe.

This ensures the client's basic hygiene, elimination, and comfort needs are met without compromising the surgical site.

Determine appropriate delegation of tasks.

Assessment of the puncture site remains the responsibility of the nurse.

UAPs are not licensed to perform clinical assessments, especially for high-risk post-procedure complications.

Key Concept

Basic care and comfort for clients with strict post-procedure mobility and positioning restrictions.

Question 730Question →

A client is prescribed a new oral penicillin antibiotic for a soft tissue infection. The practical nurse reviews the client's electronic health record and notes a documented anaphylactic reaction to cephalexin. Which action should the nurse take next?

Withhold the prescribed antibiotic and immediately inform the registered nurse or healthcare provider.

Administer the medication and closely monitor the client for signs of respiratory distress.

Give the medication as ordered, as penicillins are in a different pharmacological class than cephalosporins.

Ask the client to sign a waiver acknowledging the potential risk of an allergic reaction prior to administration.

Show answer & explanation

Answer: Withhold the prescribed antibiotic and immediately inform the registered nurse or healthcare provider.

Answer

Withhold the prescribed antibiotic and immediately inform the registered nurse or healthcare provider.

Penicillins and cephalosporins (such as cephalexin) both contain a beta-lactam ring in their chemical structure. Because of this similarity, clients with a severe or anaphylactic allergy to one have a well-documented risk of cross-sensitivity to the other. The safest and most appropriate action is to withhold the medication and notify the healthcare provider so a different class of antibiotic can be prescribed.

Step-by-Step Solution

Identify the prescribed medication and the documented allergy in the client's health record.

The client is prescribed a penicillin and has a severe allergy to cephalexin.

Reviewing allergies is a critical pre-administration safety check.

Recognize the pharmacological relationship between the two medications.

Cephalexin is a cephalosporin. Cephalosporins and penicillins share a similar beta-lactam chemical structure.

Clients with an allergy to one class have a significant risk of cross-sensitivity to the other.

Determine the safest nursing action within the practical nurse scope of practice.

The nurse must not administer the medication and must escalate the finding.

Administering the drug could trigger life-threatening anaphylaxis.

Key Concept

Penicillin and Cephalosporin Cross-Sensitivity

Estimated Time:45s

Question 731Question →

An older adult client is recovering on the medical-surgical unit 48 hours following a right above-the-knee amputation. The client's vital signs are stable, and surgical pain is adequately managed with prescribed oral analgesics. To promote optimal physical mobility and prevent a major musculoskeletal complication associated with this procedure, which action should the practical nurse take?

Assist the client into a prone position for 30 minutes three to four times a day.

Keep the residual limb continuously elevated on two pillows while the client is in bed.

Maintain the bed in a high Fowler's position during all waking hours to facilitate deep breathing.

Direct the unlicensed assistive personnel to evaluate the client's ability to independently transfer to a chair.

Show answer & explanation

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

Answer

Assist the client into a prone position for 30 minutes three to four times a day.

Following an above-the-knee amputation, the client is at an extremely high risk for developing hip flexion contractures, which can prevent the successful use of a prosthesis in the future. Placing the client in a prone position for 20 to 30 minutes several times a day provides full extension of the hip joint. This action effectively stretches the flexor muscles and prevents contracture formation, making it a critical basic care and comfort intervention to ensure optimal long-term mobility.

Step-by-Step Solution

Analyze the client's postoperative timeframe and the specific surgical procedure.

The client is exactly 48 hours post right above-the-knee amputation.

The postoperative timeframe is critical because nursing interventions for the first 24 hours (such as edema control) differ entirely from those required on subsequent days (such as contracture prevention).

Identify the primary mobility complication associated with this specific procedure.

Hip flexion contracture is a major risk that can severely impair future ambulation and prosthetic fitting.

Understanding the primary complication guides the selection of the correct preventive positioning strategy.

Evaluate the proposed nursing interventions against the goal of preventing hip flexion.

Prone positioning physically extends the hip joint, directly counteracting flexion, whereas continuous pillow elevation or prolonged sitting exacerbates flexion.

This ensures the selected action is clinically correct, safe, and remains within the practical nurse's scope of practice.

Key Concept

Postoperative Positioning and Contracture Prevention for Amputations

Question 732Question →

An older adult client with a history of type 2 diabetes mellitus and hypertension is admitted to a medical-surgical unit for an acute exacerbation of osteoarthritis. The morning medication profile includes oral metformin, oral lisinopril, oral meloxicam, and a new prescription for oral prednisone $40\text{ mg}$ . The unit pharmacy dispenses prednisone as $20\text{ mg}$ scored tablets. Which actions should the practical nurse (PN) take to safely administer and monitor these pharmacological therapies? Select all that apply.

Select all that apply

Administer the meloxicam and the prednisone during or immediately following the client's morning meal.

Monitor the client's capillary blood glucose levels more frequently during the shift.

Review the client's most recent serum creatinine and blood urea nitrogen (BUN) laboratory results prior to administration.

Administer four tablets of the dispensed prednisone to deliver the prescribed morning dose.

Verify the client's identity using their first name and the room number assigned to them on the unit.

Independently create and initiate a comprehensive teaching plan regarding the adverse effects of long-term corticosteroid therapy.

Show answer & explanation

Answer: Administer the meloxicam and the prednisone during or immediately following the client's morning meal.; Monitor the client's capillary blood glucose levels more frequently during the shift.; Review the client's most recent serum creatinine and blood urea nitrogen (BUN) laboratory results prior to administration.

Answer

The correct actions include administering the meloxicam and prednisone with food, monitoring blood glucose more frequently, and reviewing renal laboratory results.

Safe pharmacological management for this client requires addressing multiple overlapping risks. Meloxicam (an NSAID) and prednisone (a corticosteroid) are highly irritating to the gastric mucosa, so administering them with food is essential to prevent ulceration. Prednisone induces gluconeogenesis and insulin resistance, necessitating increased blood glucose monitoring in a client with pre-existing type 2 diabetes. Finally, metformin, lisinopril, and meloxicam all pose risks to or are dependent on renal function, making it critical to verify baseline serum creatinine and blood urea nitrogen (BUN) before administration.

Step-by-Step Solution

Analyze the prescribed medication profile against the client's medical history.

The client has diabetes and is receiving prednisone (increases glucose); the client is receiving meloxicam and prednisone (both cause GI upset); the client is receiving metformin, lisinopril, and meloxicam (all require renal monitoring).

Identifying drug-disease and drug-drug interactions is a critical component of pre-administration safety checks.

Evaluate the required dose for the new prednisone prescription.

The prescribed dose is

40\text{ mg}

. The available supply is

20\text{ mg}

per tablet. Calculation:

40 \div 20 = 2

tablets.

Accurate dosage calculation prevents medication administration errors.

Determine the appropriate scope of practice and safety protocols for the PN.

The PN must use two acceptable identifiers (not a room number) and can reinforce teaching but cannot independently create an initial teaching plan.

Adhering to safety standards and the PN scope of practice ensures legal and ethical care delivery.

Key Concept

Safe administration of complex pharmacological regimens requires verifying dosages, adhering to the rights of medication administration, anticipating adverse effects based on client comorbidities, and operating within the PN scope of practice.

Question 733Question →

A practical nurse is caring for a client who is 1 day postoperative following a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigation (CBI). The client suddenly reports severe lower abdominal cramping and a feeling of extreme bladder fullness. The nurse observes that irrigation fluid is infusing into the bladder, but there is no output in the catheter drainage bag. In what order should the practical nurse perform the following actions? Arrange the actions from first to last.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

1. Inspect the catheter drainage tubing for kinks, 2. Stop the continuous bladder irrigation, 3. Manually irrigate the urinary catheter, 4. Notify the registered nurse, 5. Administer a prescribed antispasmodic medication

When a client receiving continuous bladder irrigation (CBI) develops severe cramping and a lack of urinary output, it strongly indicates a catheter obstruction, most likely due to a blood clot. The first nursing action is to assess for simple mechanical issues like kinked tubing. If none are found, the CBI must be stopped immediately to prevent further fluid from infusing into an obstructed bladder, which could cause serious trauma or rupture. Next, the nurse should manually irrigate the catheter to clear the clot. Once the immediate danger is addressed and flow is restored (or if irrigation fails), the RN or provider is notified. Finally, an antispasmodic can be administered, as it is only safe to treat a bladder spasm after confirming the bladder is draining properly.

Step-by-Step Solution

Inspect the catheter drainage tubing for kinks or external compression

Rules out simple, easily reversible mechanical blockages.

This is the least invasive and fastest method to potentially restore flow before taking further steps.

Stop the continuous bladder irrigation (CBI) infusion

Halts the accumulation of additional fluid in the bladder.

Prevents bladder overdistention and potential rupture when the outflow is visibly blocked.

Manually irrigate the urinary catheter with sterile normal saline

Dislodges obstructing blood clots within the catheter.

A common complication of a TURP procedure is clot retention; manual irrigation is the standard acute intervention to clear it.

Notify the registered nurse (RN) or healthcare provider

Escalates the complication for advanced collaborative care.

Ensures the healthcare team is fully aware of the obstruction and can intervene medically if manual irrigation is unsuccessful.

Administer a prescribed antispasmodic medication

Relieves postoperative bladder spasms.

Symptom management medication is safely given only after ensuring the pain is not caused by an active fluid obstruction.

Key Concept

Prioritization of care and safety interventions for a postoperative TURP client experiencing continuous bladder irrigation obstruction.

Question 734Question →

A practical nurse (PN) is providing a complete bed bath for a bedridden client. Arrange the following body parts in the correct order in which they should be washed, proceeding from the cleanest area to the dirtiest area.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence for a bed bath is from the cleanest area to the dirtiest area: Face and neck, followed by the chest and abdomen, then the legs and feet, and finally the perineal area.

Bathing must always progress from the cleanest areas to the dirtiest areas to prevent the spread of pathogens. The correct sequence starts at the head (face and neck), moves down the trunk (chest and abdomen), continues to the extremities (legs and feet), and ends with the most contaminated region (the perineal area).

Step-by-Step Solution

Identify the core principle of bathing a client.

The principle is to wash from the cleanest area to the dirtiest area.

This prevents the transfer of microorganisms from highly contaminated areas to cleaner areas.

Determine the cleanest area among the choices.

The face and neck are washed first.

The face (especially the eyes) is highly susceptible to infection and is considered the cleanest part of the body.

Sequence the remaining body parts descending toward the lower body.

The chest and abdomen are washed next, followed by the legs and feet.

The trunk is cleaner than the lower extremities and feet.

Identify the dirtiest area to be washed last.

The perineal area is placed last in the sequence.

The perineum harbors the most microorganisms and washing it last prevents contaminating the bath water and spreading bacteria to the rest of the body.

Key Concept

The fundamental principle of personal hygiene and bathing is to clean from the cleanest area to the dirtiest area to prevent cross-contamination.

Question 735Question →

A practical nurse is preparing to apply prescribed thigh-high anti-embolism stockings for a client who has been sitting in a bedside chair for the past three hours. In what order should the nurse perform the following actions? (Arrange the steps from first to last)

Drag items to arrange them in the correct order

Show answer & explanation

Answer

First assist the client to a supine position, then elevate the legs for 15 to 30 minutes to reduce edema. Next, measure the leg for accurate sizing, invert the stocking down to the heel, and finally apply it smoothly up the leg.

The precise sequencing of anti-embolism stocking application is critical for clients who have been in a dependent position (sitting or standing). Gravity causes venous pooling and dependent edema. If the stockings are measured or applied immediately, they will be incorrectly sized and will trap the fluid. Therefore, the nurse must first assist the client to bed and elevate the legs for 15 to 30 minutes to promote venous return. Only after the edema has resolved should the nurse measure the leg, prepare the stocking by turning it inside out to the heel, and smoothly roll it on to ensure safe, effective compression.

Step-by-Step Solution

Assist the client to a supine position.

The client is safely positioned in bed.

A supine position is the mandatory prerequisite for initiating the venous return process and applying the stockings.

Elevate the legs for 15 to 30 minutes.

Dependent edema resolves and venous pooling decreases.

Applying stockings over edematous legs traps fluid in the interstitial spaces; elevating the legs first reverses gravity-induced pooling from sitting.

Measure the leg dimensions.

The correct stocking size is identified.

Measurements must reflect the true baseline size of the leg, which can only be obtained after dependent swelling has subsided.

Invert the stocking down to the heel.

The stocking is prepared for the foot.

This specific technique allows the nurse to securely position the heel before applying the tighter remainder of the stocking.

Roll the stocking up the leg smoothly.

The stocking applies graduated compression without wrinkles.

Wrinkles or bunched fabric can create a tourniquet effect, completely obstructing venous return and causing tissue ischemia.

Key Concept

Application of anti-embolism stockings and management of dependent edema

Estimated Time:1m 30s

Question 736Question →

A licensed practical nurse (LPN) is monitoring a client who returned to the nursing unit 2 hours ago following an esophagogastroduodenoscopy (EGD) with a biopsy of esophageal varices. Which of the following assessment findings should the LPN identify as indicators of a potential complication requiring immediate escalation to the registered nurse (RN)? Select all that apply.

Select all that apply

Apical pulse of 114 beats/min and a blood pressure reading of 92/58 mm Hg.

Client reports mild throat discomfort and a raspy voice when answering questions.

Continuous swallowing motions and repeated efforts to clear the airway.

A post-procedure serum potassium level of 4.1 mEq/L (4.1 mmol/L).

A hemoglobin result of 8.4 g/dL (84 g/L), decreased from a baseline of 11.2 g/dL (112 g/L).

An oral temperature of 99.2°F (37.3°C) with unlabored respirations.

Show answer & explanation

Answer: Apical pulse of 114 beats/min and a blood pressure reading of 92/58 mm Hg.; Continuous swallowing motions and repeated efforts to clear the airway.; A hemoglobin result of 8.4 g/dL (84 g/L), decreased from a baseline of 11.2 g/dL (112 g/L).

Answer

The findings requiring immediate escalation are the elevated apical pulse with hypotension, continuous swallowing motions, and the significant decrease in hemoglobin.

Following an invasive biopsy of esophageal varices, the most immediate life-threatening complication is hemorrhage. The correct answers represent the triad of active bleeding indicators: hemodynamic instability (tachycardia with hypotension), behavioral signs of pooled blood in the airway (continuous swallowing), and objective laboratory confirmation of acute blood loss (precipitous drop in hemoglobin). Because these findings indicate an impending crisis, they must be escalated to the RN immediately for advanced intervention.

Step-by-Step Solution

Analyze the clinical scenario and the specific procedure performed.

The client underwent an EGD with a biopsy of esophageal varices. Varices are enlarged, fragile veins that carry a massive risk of severe hemorrhage when traumatized.

Identifying the procedure's highest risk establishes the baseline for what complications to anticipate.

Evaluate the vital signs for indicators of hemodynamic instability.

An apical pulse of 114 beats/min combined with a blood pressure of 92/58 mm Hg indicates compensatory tachycardia and hypotension.

These are the hallmark signs of early hypovolemic shock secondary to acute blood loss.

Assess behavioral and physical cues that might indicate concealed bleeding.

The client is demonstrating continuous swallowing and throat clearing.

Because esophageal bleeding can drain silently into the stomach or pool in the throat, frequent swallowing is a primary indicator of active upper airway/GI bleeding.

Review the laboratory data for critical changes.

The hemoglobin dropped from 11.2 g/dL to 8.4 g/dL.

A rapid decrease of this magnitude confirms acute hemorrhage, requiring immediate provider notification for potential blood transfusion and surgical intervention.

Differentiate expected post-procedure findings from emergent complications.

Mild throat discomfort, a low-grade temperature (99.2°F), and a normal potassium level (4.1 mEq/L) are identified as expected or normal findings.

The LPN must avoid overreacting to routine post-operative physiological responses to maintain focus on true life-threatening emergencies.

Key Concept

Post-Procedure Hemorrhage Recognition and Escalation

Estimated Time:2m 0s

Question 737Question →

A primary care provider prescribes amoxicillin $500\text{ mg}$ orally for a client. The pharmacy dispenses an oral suspension with a concentration of $250\text{ mg}$ per $5\text{ mL}$ . How many milliliters ( $\text{mL}$ ) should the practical nurse administer per dose?

2\text{ mL}

5\text{ mL}

10\text{ mL}

25\text{ mL}

Show answer & explanation

Answer: $10\text{ mL}$

Answer

The nurse should administer

10\text{ mL}

of the oral suspension per dose.

To find the correct volume, the prescribed dose (

500\text{ mg}

) must be divided by the available dose (

250\text{ mg}

), and then multiplied by the available volume (

5\text{ mL}

). The calculation is

(500 / 250) \times 5 = 2 \times 5 = 10\text{ mL}

Step-by-Step Solution

Identify the desired dose prescribed by the provider.

The desired dose is

500\text{ mg}

This is the target amount of medication the client needs to receive.

Identify the available concentration dispensed by the pharmacy.

The available dose is

250\text{ mg}

in a volume quantity of

5\text{ mL}

This determines the ratio of medication to liquid.

Calculate the volume to administer using the formula:

(\frac{\text{Desired}}{\text{Have}}) \times \text{Quantity}

(\frac{500\text{ mg}}{250\text{ mg}}) \times 5\text{ mL} = 2 \times 5\text{ mL} = 10\text{ mL}

This provides the precise liquid volume needed to deliver the prescribed milligram dose.

Key Concept

Medication Dosage Calculation

Alternative Method

This calculation can also be solved using ratio and proportion:

\frac{250\text{ mg}}{5\text{ mL}} = \frac{500\text{ mg}}{X\text{ mL}}

. Cross-multiplying yields

250X = 2500

, resulting in

X = 10\text{ mL}

Estimated Time:1m 0s

Question 738Question →

A practical nurse is preparing to transfer a client with left-sided hemiparesis from the bed to a wheelchair. In what order should the nurse perform the following actions? (Arrange the steps from first to last.)

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence is: Position the wheelchair on the right side, lock the wheels, assist the client to sit and apply a transfer belt, brace the client's left knee, and pivot on the right leg.

The safe transfer of a client with unilateral weakness requires maximizing the use of their unaffected side while supporting their affected side. The wheelchair is positioned on the strong (right) side. Safety locks are engaged before moving the client. The client is assisted to sit and secured with a transfer belt. The nurse braces the weak (left) knee to prevent it from collapsing, and the client pivots on the strong (right) leg to safely enter the wheelchair.

Step-by-Step Solution

Place the wheelchair on the client's right (unaffected) side.

The wheelchair is accessible for the client's strong side.

Positioning the chair on the unaffected side allows the client to use their strong arm and leg to pivot safely without crossing over their weak side.

Lock the wheels on the bed and wheelchair.

The transfer environment is secured.

Locked wheels prevent the equipment from moving away, which is a primary cause of falls during transfers.

Assist the client to sit on the edge of the bed and apply a transfer belt.

The client is positioned for the transfer with a secure grip point established.

Sitting allows time to assess for orthostatic hypotension, and the transfer belt provides the nurse with a safe way to support the client's weight.

Brace the client's left (affected) knee with your own knee.

The client's weak leg is physically supported.

Bracing prevents the hemiparetic leg from buckling when the client attempts to stand.

Instruct the client to pivot on their right leg and reach for the wheelchair.

The client transfers safely into the wheelchair.

Pivoting on the strong leg ensures balance and strength are maintained throughout the movement.

Key Concept

Safe transfer techniques for clients with hemiparesis

Question 739Question →

An individual is under observation on a trauma unit following a pelvic fracture sustained the previous day. The client is resting quietly in a supine position and reports that their discomfort is well-controlled. Upon obtaining the current vital signs, the practical nurse notes a blood pressure of 110/78 mm Hg, a pulse of 108 beats per minute, and respirations of 22 breaths per minute. A review of the admission flowsheet from twelve hours prior shows a blood pressure of 132/74 mm Hg, a pulse of 78 beats per minute, and respirations of 16 breaths per minute. The indwelling urinary catheter has drained 25 mL over the past hour. Which action must the nurse take first?

Escalate the assessment findings to the supervising registered nurse without delay.

Record the findings in the client chart since the current values represent a normal physiological stress response.

Perform a comprehensive pain assessment to determine if the elevated pulse requires analgesic administration.

Delegate the task of offering clear oral fluids to an assistive colleague to help increase the urinary output.

Show answer & explanation

Answer: Escalate the assessment findings to the supervising registered nurse without delay.

Answer

The correct action is to immediately notify the registered nurse of the vital sign trends and decreased urine output, as these are subtle, early indicators of hypovolemic shock due to internal bleeding.

The client's narrowing pulse pressure, dropping systolic blood pressure, tachycardia, and decreased urine output are classic subtle signs of early compensatory shock. Pelvic fractures carry a significant risk of severe internal bleeding. Recognizing these trends and escalating care immediately reduces the risk of irreversible organ damage, which is the priority.

Step-by-Step Solution

Analyze the baseline and current vital signs to identify any significant trends.

The systolic blood pressure dropped by 22 mm Hg, the pulse increased by 30 beats per minute, and the pulse pressure narrowed significantly.

Comparing current data against baseline is essential to identify early physiological deterioration.

Evaluate the urinary output against standard minimum parameters.

The output of 25 mL over the past hour falls below the minimum expected threshold of 30 mL per hour.

Decreased urine output is an early compensatory mechanism when renal perfusion drops due to decreased circulating blood volume.

Correlate these clinical findings with the client's underlying injury.

Pelvic fractures carry a high risk for massive, hidden internal hemorrhage in the retroperitoneal space.

Understanding the risk profile of the diagnosis provides context for the physiological changes.

Determine the appropriate scope of practice action.

The nurse must escalate the findings to the registered nurse immediately.

Recognizing early shock requires rapid collaborative intervention and medical management beyond independent practical nursing actions.

Key Concept

Recognition of Early Compensatory Shock

Question 740Question →

A client with heart failure has a new prescription for furosemide $60\text{ mg}$ by mouth once daily. The pharmacy supplies furosemide oral solution with a concentration of $10\text{ mg}/1\text{ mL}$ . How many milliliters ( $\text{mL}$ ) should the practical nurse administer for each dose? Record your answer as a whole number. Do not include units in your answer.

Show answer & explanation

Answer: 6

Answer

To calculate the correct volume of furosemide oral solution, use the formula:

(\text{Desired} / \text{Have}) \times \text{Quantity}

. The desired dose is

60\text{ mg}

, the dose on hand is

10\text{ mg}

, and the quantity is

1\text{ mL}

. The calculation is

(60\text{ mg} / 10\text{ mg}) \times 1\text{ mL}

, which equals

6\text{ mL}

Step-by-Step Solution

Identify the prescribed dose (Desired).

60\text{ mg}

This is the amount of medication the provider ordered for the client.

Identify the available medication concentration (Have and Quantity).

10\text{ mg}

1\text{ mL}

This is the strength of the medication provided by the pharmacy.

Apply the dosage calculation formula:

(\text{Desired} / \text{Have}) \times \text{Quantity}

(60\text{ mg} / 10\text{ mg}) \times 1\text{ mL} = X

This formula accurately determines the correct volume to administer based on the required dose and available concentration.

Perform the calculation.

6\text{ mL}

Dividing

60

10

yields

6

, and multiplying by

1

maintains the value.

Key Concept

Calculating oral liquid medication dosages using the Desired over Have method.

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