Physiological Integrity

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.

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?

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.

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?

A nursing assistant reports updated vital signs for a client who underwent a percutaneous liver biopsy $3$ hours ago. The client's current blood pressure is $102/66$ mm Hg and heart rate is $112$ beats/min, compared to a pre-procedure baseline of $130/82$ mm Hg and $78$ beats/min. The client reports new, mild right shoulder pain. A review of the morning laboratory data shows a platelet count of $82,000/\text{mm}^3$. Which action should the practical nurse take first?

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?

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

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.

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 $3.1\text{ mEq/L}$. During data collection, the client reports new-onset nausea and generalized weakness. Which action should the PN take first?

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?

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)

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.

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

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?

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.

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?

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.

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?

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.

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.