Physiological Integrity

Upon receiving a client who just completed a percutaneous liver biopsy, the practical nurse must ensure the client is safely situated in bed. To effectively compress the biopsy site and prevent internal bleeding, which position is most appropriate?

A practical nurse is caring for a client with heart failure who is resting supine in bed. The client suddenly becomes restless and reports severe difficulty breathing. In what sequence should the nurse perform the following actions? (Arrange the actions from first to last.)

A practical nurse is preparing to transfer a client who has limited mobility from a bed to a stretcher using a lateral transfer board (slide board). The nurse has already explained the procedure to the client, gathered an assistant, and performed hand hygiene. Arrange the following steps in the correct order to safely complete the transfer.

A practical nurse (PN) is caring for a client who is 12 hours postoperative following a transsphenoidal hypophysectomy. The client reports a mild headache and increased thirst. The PN notes that the client has produced 900 mL of pale urine over the past 2 hours. Current vital signs are blood pressure 102/64 mmHg, heart rate 114 beats/min, and respiratory rate 18 breaths/min. Which of the following actions should the PN take FIRST?

A practical nurse working in a rehabilitation facility is reviewing the morning laboratory results for a resident who takes daily oral warfarin for atrial fibrillation. The resident's International Normalized Ratio (INR) is reported as 5.5. Which action is the most appropriate for the nurse to take?

A licensed practical nurse (LPN) is assisting a healthcare provider with a bedside thoracentesis for a client who has a pleural effusion. In what order should the LPN perform the following actions to reduce the client's risk of potential complications? (Arrange the steps from first to last.)

An older adult client with a history of mild dementia is receiving care for severe dehydration secondary to gastroenteritis. The client is usually cooperative but suddenly becomes extremely restless and begins pulling at their intravenous tubing. The practical nurse (PN) obtains a heart rate of 114 beats/min and a blood pressure of 94/56 mm Hg. What is the priority action for the PN?

An adult client is transferred to the medical-surgical unit 4 hours after a subtotal thyroidectomy. The client reports mild neck discomfort and difficulty swallowing. To promote comfort, minimize tissue swelling, and reduce tension on the surgical site, which position is most appropriate for the nurse to assist the client into?

A practical nurse is caring for a client who underwent a bowel resection $12$ hours ago. The client appears increasingly restless, reports an abdominal pain level of $8$ on a $0$ to $10$ scale, and requests a prescribed PRN dose of oral hydrocodone-acetaminophen. A routine dose of oral carvedilol is also due at this time. Current vital signs are blood pressure $86/52$ mmHg, apical heart rate $118$ beats/min, and respiratory rate $22$ breaths/min. Which of the following actions should the practical nurse take first?

A practical nurse (PN) is reviewing morning laboratory results for a client receiving a continuous intravenous heparin infusion. The client also began oral warfarin therapy $48$ hours ago. The client's baseline platelet count on admission was $250,000/\text{mm}^3$. The current laboratory results are as follows:

The PN is preparing to administer the scheduled morning dose of oral warfarin. Based on these findings, which of the following is the priority action by the PN?

A practical nurse is preparing to administer a mixed dose of short-acting (Regular) and intermediate-acting (NPH) insulin to a client with type 2 diabetes mellitus. Place the following steps for drawing up the insulins in the correct chronological order.

A client is 6 hours postoperative following a partial colectomy. The client's indwelling urinary catheter has drained 20 mL over the past hour. Current vital signs reveal a heart rate of 112 beats/minute and a blood pressure of 102/64 mm Hg. A recently resulted hemoglobin level is 7.6 g/dL (76 g/L). The client also reports incisional pain rated 6 on a 0-to-10 scale. Which action is the priority for the practical nurse?

While assisting a client with a history of seizure disorders during their morning meal, the individual suddenly loses consciousness and begins exhibiting rhythmic, jerking muscle movements while seated in their chair. Arrange the following nursing interventions in the correct order of priority.

A practical nurse is preparing to measure the gastric residual volume for a client who is receiving continuous enteral tube feedings. In what order should the nurse perform the following actions to reduce the risk of aspiration and other clinical complications? Arrange the steps in the correct sequence from first to last.

An adult client is recovering on the surgical unit 3 hours after a septoplasty and turbinate reduction. During a routine assessment, the practical nurse observes that the client is swallowing frequently. The client's heart rate has increased to 118 beats per minute from a preoperative baseline of 76 beats per minute, and the blood pressure is 102/64 mmHg. Which action should the practical nurse take first?

A licensed practical nurse (LPN) is providing care for a 52-year-old client admitted with an acute upper gastrointestinal hemorrhage. The client is receiving continuous intravenous (IV) fluids and is on bed rest. Which of the following actions by the LPN are essential to minimize the client's risk of further complications? Select all that apply.

A licensed practical nurse (LPN) is preparing to collect an aerobic wound culture from a client's purulent abdominal surgical incision. In what order should the LPN perform the following steps to ensure an accurate specimen? Arrange the actions in the correct chronological sequence.

While preparing medications for a pediatric client weighing $37.4\text{ lb}$, a practical nurse notes a new prescription for ibuprofen $8\text{ mg/kg/dose}$ every $6$ hours as needed for fever. The medication is available as an oral suspension of $100\text{ mg}/5\text{ mL}$. How many $\text{mL}$ should the nurse administer for one dose? (Record answer to the nearest tenth. Do not include units in answer.)

A practical nurse (PN) is caring for a client who is $12$ hours postoperative following an open abdominal procedure. The client is scheduled to receive their routine morning dose of oral lisinopril. The client states, "I feel unusually thirsty and a bit dizzy when I move." The PN obtains the following vital signs: heart rate $112$ beats/minute, blood pressure $96/58$ mm Hg, respiratory rate $20$ breaths/minute, and oxygen saturation $97\%$ on room air. Which action should the PN take regarding the scheduled medication?

A practical nurse is providing basic care for an older adult client who is completely immobile, has a high risk for pressure injuries, and is receiving continuous enteral tube feeding. The nurse is preparing to reposition the client to promote comfort and skin integrity. Which action is the most appropriate for the nurse to perform?