PN fundamental hesi V1 with answers

A client who is in hospice care complains of increasing amounts of pain.
The healthcare provider prescribes an analgesic every four hours as needed.
Which action should the LPN/LVN implement? - Give an around-the-clock schedule for administration of analgesics.

When assessing a client with wrist restraints, the nurse observes that the
fingers on the right hand are blue. What action should the LPN implement
first? - Loosen the right wrist restraint.

The LPN/LVN is assessing the nutritional status of several clients. Which
client has the greatest nutritional need for additional intake of protein? - A lactating woman nursing her 3-day-old infant.

A client is in the radiology department at 0900 when the prescription
levofloxacin (Levaquin) 500 mg IV q24h is scheduled to be administered.
The client returns to the unit at 1300. What is the best intervention for the
LPN/LVN to implement? - Give the missed dose at 1300 and change the schedule to administer daily
at 1300.

While instructing a male client's wife in the performance of passive range-
of-motion exercises to his contracted shoulder, the nurse observes that she is
holding his arm above and below the elbow. What nursing action should the
LPN/LVN implement? - Acknowledge that she is supporting the arm correctly

What is the most important reason for starting intravenous infusions in the
upper extremities rather than the lower extremities of adults? - A decreased flow rate could result in the formation of a thrombosis

The LPN observes an unlicensed assistive personnel (UAP) taking a
client's blood pressure with a cuff that is too small, but the blood pressure
reading obtained is within the client's usual range. What action is most
important for the nurse to implement? - Reassess the client's blood pressure using a larger cuff

A client is to receive cimetidine (Tagamet) 300 mg q6h IVPB. The
preparation arrives from the pharmacy diluted in 50 ml of 0.9% NaCl. The
LPN plans to administer the IVPB dose over 20 minutes. For how many ml/
hr should the infusion pump be set to deliver the secondary infusion? - 150

Twenty minutes after beginning a heat application, the client states that
the heating pad no longer feels warm enough. What is the best response by
the LPN/LVN - The body's receptors adapt over time as they are exposed to heat

The LPN is instructing a client with high cholesterol about diet and life
style modification. What comment from the client indicates that the teaching
has been effective? - I will limit my intake of beef to 4 ounces per week

) The UAPs working on a chronic neuro unit ask the LPN/LVN to help
them determine the safest way to transfer an elderly client with left-sided
weakness from the bed to the chair. What method describes the correct
transfer procedure for this client? - Move the chair parallel to the right side of the bed, and stand the client on
the right foot

An unlicensed assistive personnel (UAP) places a client in a left lateral
position prior to administering a soap suds enema. Which instruction should
the LPN/LVN provide the UAP? - Reposition in a Sim's position with the client's weight on the anterior
ilium.

A client who is a Jehovah's Witness is admitted to the nursing unit.
Which concern should the LPN have for planning care in terms of the
client's beliefs? - Blood transfusions are forbidden

The LPN/LVN observes that a male client has removed the covering from an
ice pack applied to his knee. What action should the nurse take first? - Observe the appearance of the skin under the ice pack

The LPN/LVN mixes 50 mg of Nipride in 250 ml of D5W and plans to
administer the solution at a rate of 5 mcg/kg/min to a client weighing 182
pounds. Using a drip factor of 60 gtt/ml, how many drops per minute should
the client receive? - 124 gtt/min

) A hospitalized male client is receiving nasogastric tube feedings via a
small-bore tube and a continuous pump infusion. He reports that he had a
bad bout of severe coughing a few minutes ago, but feels fine now. What
action is best for the LPN/LVN to take? - After clearing the tube with 30 ml of air, check the pH of fluid withdrawn
from the tube.

A male client being discharged with a prescription for the bronchodilator
theophylline tells the nurse that he understands he is to take three doses of
the medication each day. Since, at the time of discharge, timed-release
capsules are not available, which dosing schedule should the LPN advise the
client to follow? - 8 a.m., 4 p.m., and midnight