Which assessment should the practical nurse (PN) make to best evaluate a client's fluid status? - Daily body weight
The practical nurse (PN) is changing a postoperative dressing for a client with a horizontal lower abdominal incision. What method should the PN use to remove the tape from the dressing? - Remove all four sides by moving to the center of the incision.
A male client ho is 2 days postoperative for exploratory abdominal surgery is ambulating in the hall with the practical nurse (PN). The client tells the PN, "I think something in my incision just let go." Which action should the PN implement first? - Assist the client to a supine position.
An older client who is unable to swallow is receiving continuous NGT feeding. Before administering medications through the NGT, what action should the practical nurse implement? - Flush the feeding tube with water.
Which action should the practical nurse implement to help a male client cope with his fear as he approaches death? - Hold the client's hand and tell him he is no alone.
The practical nurse is giving oral care to an older female client with tender gums that bleed easily because of a medication she is taking. What intervention should the PN implement? - Obtain a soft-bristle brush for the client.
The practical nurse is caring for a client who is admitted with influenza and vomiting for 3 days. The clients skin turbot is poor and oral mucous membranes are dry. Which finding is most important for the PN to report to the charge nurse? - Hypotension and tachycardia
Which food should the practical nurse recommend for a client to increase the dietary intake of potassium? - Baked potatoes
When irrigating the external ear canals of an older adult client, which action should the PN use to soften dry cerumen for removal? - Instill mineral oil in the external auditory canal overnight before irrigation.
An older female state the medication tablet brought in a cup looks different from the tablet that she takes at home. Which action should the practical nurse take? - Check the written prescription to verify the medication
Which action should the PN implement when administering a subcutaneous injection to a client who weighs 325 pounds? - Select a needle with a longer shaft
Which intervention provides confirmation of NGT placement before NGT feedings are started? - X-ray of the abdomen
An older male client who is incontinent receives a prescription for a condom catheter. Which steps should the PN implement when applying the external catheter. - Wrap the adhesive strip in a spiral around the penis
Apply skin prep to the penile shaft and allow to dry
Leave 1-2 inches between the tip of the penis and condom catheter
Acetaminophen is prescribed for an unconscious client with a temp of 104' F. Which route should the PN plan to administer this medication? - Rectal
An older male client who is sedentary complains of not having a formed bowel movement in four days and tells the PN that he feels rectal pressure and has a constant headache. The PN determines the client is having frequent small, liquid stools. Which nursing action should the PN take first? - Digitally assess for impacted stool.
The PN is adding tap water to several medication for administration via feeding tube. Which preparation should the PN administer without delay? - Time release capsule
Which action should the PN follow when applying an elasticize bandage to a client's leg? - Overlap turns of the bandage equally
The PN obtains an elevated blood pressure reading for an older male client is is alert. When the PN offer the client his morning blood pressure medication, he refuses to take it. What action should the PN take? - Explain the importance of routine use of antihypertensives.
What position should the PN place client in who is receiving an enteral tube feeding? - Supine with the head of bed elevated to 30-45 degrees.
The PN is preparing an intramuscular injection for a client who is 5 feet tall and weighs 90 pounds. Which needle size should the PN select for a 3 mL syringe when using the IM ventrogluteal injection site? - 1 inch
An older male client tells the PN that his religion does not permit him to bathe daily. How should the PN respond? - Request that the client clarify his religious beliefs about bathing.
The PN identifies several findings in an older female who is on prolonged bed rest. Which finding requires prompt action by the PN? - Bowel movements decreases to one every third day.
A client is prescribed a medication that is labeled as a sustained released (SR). What action should the PN implement when administering this drug form? - Do not crush or dissolve the table or capsule contents
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