Case Information CASE 1 Mrs.

Jackson, 58 years old, has been admitted to a four-bed room on a medical unit with a diagnosis of pneumonia. QUESTIONS 1 to 5 refer to this case 1. The physician's orders for Mrs. Jackson include sputum specimen for C&S and acid-fast bacilli (AFB). What is the correct method for the client to collect the sputum specimen? 1. 2. 3. 4. Rinse mouth with mouthwash and collect the specimen p.c. breakfast. Collect the specimen in a sterile container at h.s. after deep breathing and coughing. Collect the specimen a.c. breakfast after rinsing mouth with water. Rinse mouth with water and collect at hs.

2. Mrs. Jackson's sputum specimen has come back positive for AFB, and a diagnosis of tuberculosis has been made. Which nursing intervention is correct? 1. 2. 3. 4. Move Mrs. Jackson to a private room using reverse isolation. Use enteric isolation precautions when providing care for Mrs. Jackson. Use disposable dishes and equipment in Mrs. Jackson's room. Move Mrs. Jackson to a private room with negative air flow.

3. Mrs. Jackson has to go to the radiology department for a chest x-ray. What should the practical nurse do? 1. 2. 3. 4. Have Mrs. Jackson wear a mask while out of her room. Suggest that a portable x-ray be brought to Mrs. Jackson's room. Advise the x-ray department and advise all staff to wear a mask. Wear a mask and gloves while transporting Mrs. Jackson.

4. Which action represents appropriate risk management interventions for tuberculosis? 1. 2. 3. 4. Teaching Mrs. Jackson about the medications she is taking for tuberculosis Monitoring the clients exposed to tuberculosis for signs and symptoms of the disease Offering to request a lab test for tuberculosis for those clients exposed Placing clients exposed to tuberculosis on droplet precautions until lab results return

5. Mrs. Jackson can expect which therapeutic regime for tuberculosis? 1. 2. 3. A chest x-ray, a cough suppressant, and an antibiotic Follow-up sputum specimens, physiotherapy, and a series of chest x-rays A series of chest x-rays, several antibiotics, and follow-up sputum specimens

4.

Follow-up sputum specimens, chest physiotherapy, and bronchodilator medications

Case Information CASE 2 Ms. Saunders, 23 years old, has been admitted with a diagnosis of anorexia nervosa. She has participated in the development of her care plan. QUESTIONS 6 to 11 refer to this case. 6. Ms. Saunders states, "Everyone is overreacting to my condition and I would do much better with treatment at home." This statement by Ms. Saunders reflects which one of the following? 1. 2. 3. 4. Acceptance of her condition Fear of her condition Denial of her condition Understanding of her condition

7. Which one of the following examples from Ms. Saunders' chart uses appropriate abbreviations? 1. 2. 3. 4. "Sympt. of anorexia presented" "Enc. client to discuss feelings" "Stated goal is wt. gain of 4 kg" "Discussed wgt loss"

8. What aspect of Ms. Saunders' care should take priority for the practical nurse? 1. 2. 3. 4. Building a trusting relationship with her Reviewing the care plan with her Discussing her nutrition with the dietitian Assisting her to identify coping skills

9. Ms. Saunders has lost 1 kg in the past week. Which one of the following responses by the practical nurse would best help Ms. Saunders meet her nutritional needs? 1. 2. 3. 4. "Eating may speed up your discharge." "Let's review your goals from your care plan." "Would you like to see the dietitian?" "Shall we take it one day at a time?"

10. The practical nurse notices Ms. Saunders hiding food under her dinner tray and comments on it. Ms. Saunders says, "Quit telling me to eat!" Which one of the following responses should the practical nurse make? 1. 2. "Ms. Saunders, you need to review your nutritional goals." "You should try to eat all the food on your tray."

3. 4.

"You have an eating disorder and we want to help you with it." "I want you to tell me why you are here."

11. The practical nurse finds Ms. Saunders crying and pacing in her room. Which one of the following entries is acceptable for the practical nurse to record in Ms. Saunders' chart? 1. 2. 3. 4. "Found Ms. Saunders crying and pacing." "Observed crying and pacing in her room." "Entered her room, Ms. Saunders is upset." "Crying and agitated. "

Case Information CASE 3 Mr. Antonio, 45 years old, is admitted to the palliative care unit with pancreatic cancer. His wife and two teenage children accompany him. He states that he has abdominal pain. He is jaundiced and has ascites. The physician has told them that Mr. Antonio will live only a few more weeks. QUESTIONS 12 to 15 refer to this case. 12. Mr. Antonio requests a vegetarian diet. The physician has ordered a regular diet with supplements. How should the practical nurse proceed? 1. 2. 3. 4. Advise Mr. Antonio to discuss his dietary request with the physician. Suggest that Mrs. Antonio bring vegetarian meals from home. Inform Mr. Antonio that protein is required for his disease process. Notify the dietitian of Mr. Antonio's need for a change in the meal plan.

13. Mrs. Antonio asks how she and her children will know that her husband's death is getting closer. How should the practical nurse respond? 1. 2. 3. 4. "You will hear the death rattle right before he dies." "His breathing may slow with longer periods between breaths." "There is really no way of knowing when it will happen." "The nursing staff will give you enough time to call the family."

14. Mrs. Antonio calls the practical nurse to the bedside because her husband is taking his last breaths. Mrs. Antonio starts to cry and tremble. How should the practical nurse respond? 1. 2. 3. 4. Reassure Mrs. Antonio that her husband is no longer suffering. Inform Mrs. Antonio that pastoral care will be contacted to comfort her family. Stand quietly at the bedside with Mrs. Antonio and her children. Ask her if there is anyone else that she would like the nursing staff to call.

15. Mr. Antonio dies, and the physician orders an autopsy to confirm metastatic involvement. Mrs. Antonio does not want the autopsy because of her religious belief that the body be kept intact. How should the practical nurse respond? 1. 2. 3. 4. Advise her that the autopsy should be done and nothing will be removed from her husband's body. Inform her that the physician will be notified of her wish not to have an autopsy done on her husband Encourage Mrs. Antonio to talk with pastoral care about the importance of an autopsy on her husband. Explain to Mrs. Antonio that the results of the autopsy may benefit others, including her children.

Case Information CASE 4 Tom is a healthy, full-term newborn. He is the first child for Mr. and Mrs. Cane. QUESTIONS 16 to 20 refer to this case. 16. Which intervention should the practical nurse suggest if Tom develops diaper rash? 1. 2. 3. 4. Apply liberal amounts of baby powder. Frequently cleanse the skin with an antibacterial soap. Expose the buttocks to air several times a day. Thoroughly wash the skin with disposable diaper wipes.

17. Which nursing measure should be implemented when caring for Tom immediately following a circumcision? 1. 2. 3. 4. Position him on his side to decrease edema to the area. Place a dry dressing on the area to keep it clean. Expose the area to air to encourage healing. Cover the area with vaseline and gauze to avoid irritation.

18. During assessment of Tom's respirations, which finding would alert the practical nurse that he is experiencing respiratory distress? 1. 2. 3. 4. His breathing is shallow and irregular. His respiratory rate is 45 breaths/min. His mouth remains open and there is flaring of the nares. His chest wall is showing intermittent substernal retraction.

1 9.The parents ask the practical nurse when is the best time to bathe Tom. Which response is most appropriate?

1. 2. 3. 4.

"Bathing should be done after feeding so that hunger will not interfere with the bath." "Tom should be bathed every morning to get him into a routine." "The evening is the best time because it will help Tom sleep." "Bathing should be done before feeding to avoid regurgitation."

20. Tom is being bathed by his parents for the first time. The practical nurse needs to chart the parents' comfort and knowledge level in bathing their baby. Which statement would be the most appropriate to chart? 1. 2. 3. 4. "Parents are now ready to bathe Tom independently." "Parents expressed an interest and desire to do another bath." "Parents stated that the bath experience was rewarding." "Parents demonstrated ability and ease in bathing Tom."

INDEPENDENT QUESTIONS QUESTIONS 21 to 100 do not refer to a case. 21. The practical nurse enters Mrs. Stem's room to administer the 08 00 h insulin dose. Mrs. Stem states, "That is not my usual dose of insulin." How should the practical nurse respond to Mrs. Stem? 1. 2. 3. 4. "Let me check the medication order again and I'll be back in a few minutes." "I'll check with my colleague, who is right here to see if this is the right dose." "I saw your insulin order about 1 hour ago and this is what the physician ordered." "Mrs. Stem, I know what I am doing and you should trust me, this is the correct dose."

22. Mrs. Soh, 65 years old, is 3 days postoperative. She is experiencing nausea and vomiting. What should the practical nurse do? 1. 2. 3. 4. Place bed in semi-Fowler's (45) Document client condition Auscultate bowel sounds Provide a glass of water

23. Actions would be most effective in helping Mrs. Norling? 1. 2. 3. 4. Suggest that she meet others who have had a colostomy. Respect her right to remain in her room and be angry. Provide her with pamphlets on coping with a colostomy. Demonstrate the ease of her appliance change.

24. Which one of the following best describes the concept of Universal/Standard Precautions?

1. 2. 3. 4.

It is a method of infection control used only when the client tests positive for a communicable disease. It is a method of sterilization that is followed in emergency and high-risk clinical situations. It is a process where soiled articles are separated from clean hospital supplies. It is a system of generic infection control practices for all clients.

25. Mrs. Albiani, 72 years old, has pneumonia. What assessment should the practical nurse expect to find during auscultation? 1. 2. 3. 4. Wheezing Tactile fremitus Crackles Hyperresonance

26. What action is best when the practical nurse observes that a client's drug dosage for an antihypertensive medication is twice the recommended dose for that medication? 1. 2. 3. 4. Take the client's vital signs before proceeding with administration. Take the client's blood pressure every 1 to 2 hours. Check with the client to determine how long she has been taking the medication. Re-check the dosage on the physician's order sheet.

27. Mr. Harrison, 29 years old, is experiencing anxiety following a diagnosis of testicular cancer. What should the practical nurse do? 1. 2. 3. 4. Ask him if he is concerned about not having children. Encourage him to verbalize his feelings. Suggest that he talk to his significant other. Refer him to a testicular cancer support group.

28. Ben is a frail, 18-year-old client who is in the end stages of AIDS. He has open areas on his upper and lower extremities. He is having severe, persistent pain and is due to receive morphine sulfate (Morphine) 10 mg subcutaneously. Which of the following nursing interventions best applies when the practical nurse prepares to administer morphine to Ben? 1. 2. 3. 4. Inject the morphine in the upper abdomen using a inch needle at 45. Inject the morphine in the upper arm using a 1 inch needle at 45. Contact the pharmacist and ask if morphine can be absorbed subcutaneously. Call the physician and request an alternative route for morphine.

29. The practical nurse is asked by a colleague to witness the wastage of two narcotic tablets that have fallen on the floor. After co-signing the narcotic sheet, the practical nurse sees the colleague put the two tablets in a uniform pocket. Which action must the practical nurse take?

1. 2. 3. 4.

Report and document the incident. Encourage the colleague to attend a self-help group for professionals. Ignore the incident and observe for further occurrences. Telephone the discipline committee of the regulatory body.

30. An elderly male client with alcoholism states that he is thinking of committing suicide and asks that this information be kept confidential. Which one of the following responses is most appropriate for the practical nurse to make? 1. 2. 3. 4. "For your own safety, I have to report this immediately." "You are not really serious about this?" "Have you spoken to your physician about this?" "Are you drinking more now?"

31. The practical nurse is asked to set up an IV infusion of 1,000 ml normal saline for a client. Which one of the following actions is the first responsibility of the practical nurse? 1. 2. 3. 4. Explaining the procedure to the client Teaching the client about IV/infusion therapy Verifying the physician's order for the client Assembling the equipment at the client's bedside

32. Mrs. Paquette, 65 years old, reports that her toenails are thick, yellow, and difficult to trim. Which one of the following measures by the practical nurse would best promote wellness? 1. 2. 3. 4. Suggest that she visit a foot care specialist for nail trimming. Demonstrate how to trim her toenails short and rounded at the corners. Trim her toenails after they have soaked in hot water for 10 minutes. Suggest that she use small sharp scissors for trimming her toenails.

33. The practical nurse is working in a pediatric unit for the first time. The practical nurse's first assignment is to catheterize a 5-year-old female client. The practical nurse has never performed this procedure before. What should the practical nurse do? 1. 2. 3. 4. Refer to a pediatric textbook and perform the catheterization. Review the procedure and ask another nurse to perform the catheterization. Take the procedure manual to the room and perform the catheterization. Review the procedure manual and seek assistance with the catheterization.

34. The client is receiving infusion therapy of normal saline (0.9%) in the left forearm. On assessment, the practical nurse notes that the solution is not dripping into the drip chamber. What should the practical nurse do?

1. 2. 3. 4.

Check the site, look for obstruction of tubing, and reposition arm. Check the site, reposition arm, and raise the solution container. Close off drip chamber, reposition arm, and re-regulate flow clamp. Close off drip chamber, raise the solution bag, and reposition arm.

35. The practical nurse witnesses Mrs. Fraser, 72 years old, being handled roughly by another staff member. What should the practical nurse do first? 1. 2. 3. 4. Report the staff member to the nurse-in-charge. Ensure the physician is informed and document the incident. Reassign Mrs. Fraser to another staff member. Discuss the incident with the staff member and document.

36. Mr. McNamara, 48 years old, with Type II diabetes mellitus has been started on insulin. He asks the practical nurse if he now has Type I diabetes. What is the practical nurse's best response?
1. "No, insulin can be prescribed for people with Type II diabetes."

2. 3. 4.

"You can have Type I and Type II diabetes at the same time." "Would you like to speak with the diabetes educator?" "Taking insulin will prevent you from developing Type I diabetes.

37. Mr. Freeborn, 78 years old, has dementia and is in a long-term care unit. As the practical nurse leads him to the shower, he starts to scream and pulls away. What should the practical nurse do? 1. 2. 3. 4. Check if he has an order for a sedative. Remove him from the area and try the shower later. Show him others being showered so he knows it is safe. Ask his wife if she will come and help with his shower.

38. Jeff, 14 years old, has returned to the unit following application of a right wrist cast. The practical nurse observes that Jeff's fingers are cold and edematous. What should the practical nurse do immediately? 1. 2. 3. 4. Lower the affected limb. Report the observations. Obtain a cast cutter. Assess right radial pulse.

39. Mr. Andrew, a 22-year-old client with an unstable cardiac defect, is admitted to a medical unit for telemetry monitoring. The practical nurse has been assigned as the primary care provider for this client. What should the practical nurse do in this situation? 1. Continue to care for Mr. Jones, monitoring his condition closely.

2. 3. 4.

Discuss the assignment with the nurse-in-charge. Ask for assistance from the other practical nurse on the unit. Discuss concerns regarding this client assignment with the physician.

40. Which of the following data are most important for the practical nurse to have when caring for a client with an IV infusion at home? 1. 2. 3. 4. IV/infusion therapy prescribed; appropriate infusion control device for this client Client diagnosis; response to infusion therapy in the hospital Client's ability to ambulate; available home storage area for equipment Home floor plan to accommodate need for medical asepsis; caregiver support

41. Mr. Simpson, 85 years old, was recently admitted to hospital with dementia. Which one of the following actions should the practical nurse take in determining the amount of assistance Mr. Simpson requires at mealtime? 1. 2. 3. 4. Ask Mr. Simpson to describe his eating habits. Consult the physician about Mr. Simpson's food preferences. Ask the nurse-in-charge. Check the nursing care plan.

42. What should the practical nurse do when discontinuing an IV? 1. 2. 3. 4. Wear sterile gloves, remove IV catheter, apply pressure on the site. Wear disposable gloves, remove IV catheter, apply pressure on the site. Wear sterile gloves, apply pressure below the site, remove IV catheter. Wear disposable gloves, apply pressure below the site, remove IV catheter.

43. Mr. Connell, 65 years old, has end-stage cancer and requires narcotics for pain management. When should the practical nurse administer this medication to Mr. Connell? 1. 2. 3. 4. When he states that he is experiencing pain On a regular schedule, as ordered, before his pain recurs Upon non-verbal signs of pain When there is a change in his vital signs

44. s. O'Dell, 28 years old, is being treated for a pelvic inflammatory disease. The physician orders a vaginal cream to be applied b.i.d. What instruction should the practical nurse give Ms. O'Dell regarding the application of the cream? 1. 2. "Apply cream with sterile gauze." "Wash your hands before and after applying the cream.""U

3. 4.

se gloves when applying the cream." "Withhold the application of the cream during menses."

45. Mrs. Jones, 54 years old, has multiple sclerosis and a self-care deficit due to decreased mobility. Which one of the following actions should be the practical nurse's first priority when providing Mrs. Jones' early morning care? 1. 2. 3. 4. Help her with mouth care Offer toileting Assist with bed bath Perform special skin care

46. Mrs. Estevan, 73 years old, has been recently prescribed an oral antihypertensive medication. What should the practical nurse do when administering this drug? 1. 2. 3. 4. Measure her blood pressure just before giving her the drug. Withhold the medication when her diastolic BP is less than 80 mmHg. Assess the effectiveness of the drug 15 minutes after administration. Ensure her medication is administered with meals.

47. What are the initial signs and symptoms of a blood transfusion reaction? 1. 2. 3. 4. Hypertension and blurred vision Fever and urticaria Confusion and diaphoresis Drowsiness and headache

48. Mrs. Aglukaark, a 79-year-old Inuit woman from Nunavut, speaks limited English. She has been diagnosed with Type I diabetes mellitus and was transferred to a metropolitan hospital for development of a treatment regimen and teaching. How can the practical nurse best assist in teaching Mrs. Aglukaark about her diabetic diet? 1. 2. 3. 4. Encourage Mrs. Aglukaark to attend a group session on diabetic diets. Use illustrated teaching materials to help Mrs. Aglukaark's understanding. Repeat key terms and directions to reinforce Mrs. Aglukaark's learning. Provide a copy of a standard diabetic diet for Mrs. Aglukaark to take home to Nunavut.

49. client has just received 2 units of packed cells for anemia. What client teaching should the practical nurse reinforce when the transfusion is discontinued? 1. 2. 3. Any unusual manifestations should be reported. A fluid intake of 3,000 ml should be maintained. Ambulation should be limited for 2 hours following the transfusion.

4.

Measurement of fluid intake and output is required.

50. Mr. Fung, 80 years old, has had Type II non-insulin dependent diabetes for 30 years. He lives alone but his daughter lives nearby. The practical nurse is reviewing his newly prescribed medications with him. What should the practical nurse keep in mind when planning his teaching? 1. 2. 3. 4. It is important that his daughter help him take his medications. He may need information in large print materials. His poor circulation may interfere with the learning. Expect to repeat the information over and over.

51. Mr. Smyth has been admitted to the medical unit in renal failure. After 5 years of renal dialysis, he has decided to discontinue his treatments. The physician disagrees with his decision. Which statement by the practical nurse would be most appropriate? 1. 2. 3. 4. "Could you discuss this further with your physician?" "Tell me what led you to make this decision." "Is your family aware of your feelings?" "I hope that you will reconsider your options."

52. Mrs. Mitchell requires digoxin (Lanoxin) 0.125 mg once a day. The practical nurse uses unit stock to dispense this medication. The unit stock of digoxin is available only in 0.25 mg scored tablets. How many tablets should the practical nurse give Mrs. Mitchell? 1. 2. 3. 4. 0.5 1.0 1.5 2.0

53. Mrs. MacPhee, 55 years old, has Clostridium difficile and is admitted to a semi-private room. What is the most appropriate action for the practical nurse to take? 1. 2. 3. 4. Transfer client to a private negative pressure room. Transfer client to a private room and use mask. Institute contact precautions. Institute droplet precautions.

54. Mrs. Grant takes a diuretic twice daily for hypertension and subsequently develops nocturia. Which one of the following responses is most appropriate for the practical nurse to make? 1. 2. 3. "Ask your physician to change the medication." "At what times are you taking your diuretic?" "Are you taking the potassium supplement as prescribed?"

4.

"Decrease your fluid intake to 1,000 ml per day."

55. A client is receiving an anticoagulant subcutaneously. Which one of the following statements best explains why aspiration following insertion of the needle is contraindicated? 1. 2. 3. 4. The increased vacuum on the tissues would lead to damage and bruising. Subcutaneous tissue usually contains only small blood vessels, and unintended IV injection is minimal. An injection given at a 45 angle will not enter a blood vessel. The length of the needle used for a subcutaneous injection is too short to penetrate the tissues containing the larger blood vessels.

56. Mrs. Brook, 52 years old, weighs 150 kg, fell out of bed and is not able to get back up. Which action should the practical nurse take? 1. 2. 3. 4. Assist her to a sitting position. Use the mechanical lift for Mrs. Brook. Apply a transfer belt to assist Mrs. Brook up. Call other nursing personnel for assistance.

57. Mr. Poole, 59 years old, has Type I insulin-dependent diabetes mellitus and chronic obstructive pulmonary disease. The practical nurse is reviewing with him the corticosteroid that he will be taking at home. Which one of the following factors is most important for Mr. Poole to know prior to discharge? 1. 2. 3. 4. Corticosteroids can cause congestive heart failure. He may find he has more hair on his arms and legs. He may need an increase in the amount of insulin. Corticosteroids can cause chest pain.

58. Claire, 16 years old, is admitted to hospital. She has an indwelling catheter. What should the practical nurse tell Claire to help avoid potential complications? 1. 2. 3. 4. Wear gloves while doing perineal care. Clamp the catheter tubing when showering. Avoid raising the catheter bag above the bladder. Tape the catheter tubing to her abdomen.

59. June, 13 years old, is admitted with upper respiratory tract infection at 02 00 h. Her vital signs are T 38.3 C, HR 110, and RR 24 on admission. Which of the following indicates a deteriorating condition requiring the physician to be contacted? 1. 2. Frequent non-productive coughing spells and fatigue Temperature increases to 38.6 C with flushed cheeks

3. 4.

Eyes bulge when coughing, followed by expectoration Rapid heart rate, T 38.6 C, and restlessness

60. While the practical nurse was on vacation, new infusion devices were brought to the unit. What should the practical nurse do on return to the unit? 1. 2. 3. 4. Have a coworker demonstrate use of the new device. Request an orientation to the new device. Continue to use the original devices temporarily. Refuse to use the device and request reassignment

61. A 37-year-old female client asks the practical nurse what her tests results indicated. What is the best response to give the client? 1. 2. 3. 4. Recommend that she speak to her physician. Inform her of the results of the tests. Advise her that the results are not available. Suggest she speak to the team leader.

62. Ms. Eisnor, 25 years old, has been prescribed Tylenol #3 for postoperative pain management. What is the most common side effect associated with this medication? 1. 2. 3. 4. Diarrhea Fatigue Insomnia Constipation

63. Mrs. Boyce, 78 years old, is 2 days postoperative following abdominal surgery and requests to walk to the bathroom. Which action by the practical nurse will encourage Mrs. Boyce's independence? 1. 2. 3. 4. Stay nearby as she ambulates. Develop a plan of ambulation with physiotherapy. Encourage Mrs. Boyce to use a wheelchair. Insist she needs help with ambulation.

64. Mrs. Dionne, 75 years old, has been prescribed salbutamol sulfate (Ventolin) inhaler q.i.d. What information should the practical nurse give Mrs. Dionne when she is discharged? 1. 2. 3. Avoid shaking the inhaler when using an aerochamber. Do not rinse mouth after using the inhaler. It is important to rinse the inhaler once a week.

4.

The medication must be taken according to a regular schedule.

65. Mrs. Connor, 38 years old, is 3 days postoperative following a bowel resection for Crohn's disease. During assessment, Mrs. Connor states that she felt a sharp pain in her abdomen during the night but it went away. The practical nurse notices the colour of the drainage from the JacksonPratt has changed from pink to brown. What should be done following abdominal assessment? 1. 2. 3. 4. Change the dressing. Have the physician contacted. Send the drainage for C&S. Administer an analgesic.

66. Mrs. Braun, 20 years old, has paraplegia. She refuses her morning bath for the first time since admission 1 week ago. Which one of the following responses by the practical nurse would be most appropriate? 1. 2. 3. 4. "You have never done this before. Why now?" "You need to have your bath." "There is no hurry for your bath." "You do not want a bath this morning?"

67. Tommy, 4 years old, is going for a tonsillectomy. How would the practical nurse best explain postoperative IV to Tommy? 1. 2. 3. 4. Show him a video explaining the initiation of an IV. Give him a cartoon picture book showing a character with an IV. During the explanation, show him a doll with an IV attached. Take him to another pediatric client's room and show him the IV.

68. Mrs. Wong, 88 years old, has a feeding tube in place. What should the practical nurse do when administering medications to Mrs. Wong? 1. 2. 3. 4. Elevate Mrs. Wong's bed to 45, and clear the tubing with water after each medication. Elevate Mrs. Wong's bed to 90, and crush all her medications. Elevate Mrs. Wong's bed to 45, and add her medications to the feeding solution. Elevate Mrs. Wong's bed to 90, and have her remain in this position for 30 minutes.

69. Mrs. Kennedy, 58 years old, is to begin a bladder retraining program. Which instruction should the practical nurse provide to Mrs. Kennedy? 1. 2. 3. Attempt to void every 2 hours when awake. Drink 250 ml of cranberry juice with each meal. Attempt to void every 4 hours throughout each 24-hour period.

4.

Consume a fluid intake of 1,000 ml every 24 hours.

70. Mr. Kruger, 26 years old, is recovering from injuries sustained in a fight. He has propositioned the practical nurse caring for him, asked her out on dates, and asked for her phone number. What should the practical nurse do? 1. 2. 3. 4. Ask the nursing supervisor for an assignment change. Joke with Mr. Kruger and change the subject. Tell Mr. Kruger that his comments are inappropriate and not appreciated. Ask the nursing supervisor to meet with Mr. Kruger to discuss his behaviour.

71. The practical nurse is the team leader on the long-term care unit. The client care worker reports that Mrs. Hope, 92 years old with Type I diabetes mellitus, received the wrong food tray at lunch and has started eating the meal. What should the practical nurse do first? 1. 2. 3. 4. Have the client care worker replace the incorrect foods. Ask Mrs. Hope's care worker to remove the tray. Assess Mrs. Hope's blood glucose level immediately. Ensure that the error is reported to the clinical manager.

72. Mr. Jones, 72 years old, has a diagnosis of congestive heart failure. He has a history of shortness of breath. How should the practical nurse position Mr. Jones in bed? 1. 2. 3. 4. Trendelenburg position Semi-Fowler's position Orthopneic position Supine position

73. The practical nurse notices a discrepancy between the physician's order sheet and the transcribed medication sheet. The practical nurse consults with a more experienced practical nurse, who advises to go ahead and give the medication as transcribed. What would be the most appropriate action by the practical nurse? 1. 2. 3. 4. Give the medication as transcribed on the medication record. Contact the hospital pharmacist to clarify the order. Request verification of the order with the physician. Document that the order was transcribed incorrectly.

74. Mr. Nicholson, 50 years old, has been ordered a blood transfusion. Which action is appropriate for blood transfusion? 1. 2. 3. Infuse at 100 ml per hour. Ensure the blood has been double-checked. Start a primary infusion of dextrose.

4.

Ensure the blood is left at room temperature for at least 30 minutes.

75. Mrs. MacNeil, 52 years old, is admitted to hospital and requests her monthly vitamin B12

injection, which her daughter administers at home. The medication is in her suitcase. What is the most appropriate action for the practical nurse to take?
1. 2. 3. 4. Obtain the vitamin B12 from her suitcase and administer to Mrs. MacNeil. Check for a written order for her monthly vitamin B12 injection. Verify lab values before administering the vitamin B12 injection. Tell Mrs. MacNeil that she will have to get her daughter to give the vitamin B12.

76. A 19-year-old female client is being assessed by the practical nurse for amenorrhea. Which question should the practical nurse ask initially? 1. 2. 3. 4. "Does your mother have the same symptoms?" "Are you taking oral contraceptives?" "Is there a possibility that you are pregnant?" "Have you been on a strict diet?"

77. The practical nurse assesses an IV site of insertion and finds the area swollen, cool to touch, and painful. What should the practical nurse do next? 1. 2. 3. 4. Report the observation to the nurse-in-charge, who will chart the findings. Chart the observation immediately. Identify the observation as infiltration and report to the nurse-in-charge. Recognize the observation as phlebitis and record.

78. Ms. Jensen, 19 years old, is admitted for an elective abortion. While the practical nurse is preparing the client, Ms. Jensen asks, "Would you do this if you were in my situation?" Which response by the practical nurse is most appropriate? 1. 2. 3. 4. "You sound unsure, would you like to talk further?" "Why do you ask what I would do if I were in your situation?" "No, it would not be my choice, but you can make your own decision." "I will ask the social worker to come and speak with you."

79. Betty, 18 years old, has a fractured left radius and humerus. Which one of the following actions should the practical nurse perform to assist Betty, who is left-handed, with her meals? 1. 2. 3. 4. Sit beside her to feed her. Ask her family to bring in her favourite foods. Select her menu for her. Help her cut her meat.

80. The practical nurse has offered to help a colleague give a bed bath to Mrs. Polo who is 90 years old. Upon entering the room, the practical nurse observes that Mrs. Polo is completely undressed and the blankets are at the foot of the bed. Which initial approach by the practical nurse is the most appropriate? 1. 2. 3. 4. Cover Mrs. Polo with a sheet and continue the bath. Close the curtains around the bed. Explain to the colleague that Mrs. Polo's privacy should be maintained at all times. Explain to the colleague later that it is inappropriate to uncover a client completely

81. Mr. Yaremchuk, 44 years old, is to receive a transfusion of 2 units of packed cells. Which of the following would be prevented by priming the blood tubing with normal saline rather than a dextrose solution? 1. 2. 3. 4. Burning at the site Febrile reaction Hemolysis Urticaria

82. Mrs. Rosenbloom, 73 years old, has become blind as a result of Type II non-insulin-dependent diabetic retinopathy. How should the practical nurse best provide new dietary information for Mrs. Rosenbloom prior to her hospital discharge? 1. 2. 3. 4. Provide the new information in an audio recording which she could replay at home. Provide print materials which her family could read to her. Plan several teaching sessions so she will not be overwhelmed with information. Suggest that she contact a meal delivery service.

83. Mrs. MacDonald, 68 years old, had a total knee replacement. She reports pain, and feels hot and sweaty. There is swelling and yellowish drainage from the incision. What is the most likely cause of these symptoms? 1. 2. 3. 4. Infection of surgical incision Incisional hematoma Septicemia Neurovascular compromise

84. While monitoring a 65-year-old male client during a blood transfusion, the practical nurse notices the flush solution is Dextrose 5%. What is most important for the practical nurse to note? 1. 2. 3. The client is being monitored for blood glucose reaction. Flush solution is incorrect. Vital signs are stable.

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Blood transfusion is proceeding well.

85. The practical nurse enters the room in time to see a client pulling out his IV catheter. What should the practical nurse do? 1. 2. 3. 4. Instruct the client to apply a clean gauze over the site. Have the client elevate his IV arm above the level of the heart. Put on gloves, and apply pressure to the site. Apply pressure to the site, and raise the client's arm.

86. On a surgical unit, the practical nurse's assignment includes ambulating a postoperative client, medicating a client in pain, changing a client's fecal-contaminated dressing, and removing a Foley catheter for a client being discharged. What is the priority action for the practical nurse? 1. 2. 3. 4. Assess the client in pain and administer analgesic. Ambulate the postoperative client. Change the client's abdominal incision dressing. Remove the Foley catheter and provide discharge teaching.

87. A 71-year-old female client, admitted with a personality disorder, refuses to leave her room even for bathing. It has been 2 weeks since she last bathed. Staff are concerned with her body odour. What should the practical nurse do? 1. 2. 3. 4. Inform her that the facility requires that all clients must bathe weekly. Offer to assist the client with a sponge bath in her room. Ask her family for permission to insist that the client bathe regularly. Allow the client to retain control over her own hygiene.

88. Mr. Tosoni, an 85-year-old widower, is receiving morphine sulfate because he is dying from cancer. His daughter asks the practical nurse that her father be told that the medication is liquid Tylenol because he would be upset to know he is on "that addictive stuff." What is the practical nurse's best response to the daughter? 1. 2. 3. 4. "You will need to tell him, as I am not going to mislead him." "Your father has a right to know what he is receiving." "I can provide you with information on addiction and pain medications." "You will need to sign a release form that allows me to do this."

89. Mrs. Singh, a 75-year-old woman with renal failure, has gained 1 kg in 1 day. What should the practical nurse do? 1. 2. 3. Review her diet choices with her. Encourage her to wear anti-embolic stockings. Assess her intake and output record.

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Restrict her fluid intake.

90. Mr. Graham, a 48-year-old Aboriginal elder, is dying from cancer. The eldest son asks the practical nurse if a healing circle can be held at Mr. Graham's bedside. Which response by the practical nurse demonstrates sensitivity to client diversity? 1. 2. 3. 4. "Would you like me to call the Aboriginal support worker?" "Can you tell me what is involved in a healing circle?" "Would this ceremony affect other client's activities?" "What day were you planning to have the healing circle?"

91. What should the practical nurse do to prepare a diuretic for administration through a nasogastric feeding tube? 1. 2. 3. 4. Order an injectable preparation of the medication. Crush the tablet and mix with 30 ml of water. Dissolve the tablet for 30 minutes in 20 ml of water. Break the tablet in half and mix with tube feeding.

92. Ms. Johansen, 32 years old, is 8 hours postpartum and has not voided. What should the practical nurse do initially? 1. 2. 3. 4. Determine the position of the fundus. Catheterize the urinary bladder. Observe for swelling of the perineum. Run water while the client tries to void.

93. The unit staff is very busy. A staff nurse has prepared a medication and asks the practical nurse to administer the client's medication during breakfast. What should the practical nurse do? 1. 2. 3. 4. Ensure thorough understanding of the instructions before beginning the procedure. Record on the chart the time of administering the medication. Remind the staff nurse that this is not appropriate. Provide a written report of the incident.

94. Mr. Coleman, 77 years old, has an ulcer on his coccyx. During morning report, the practical nurse learns that Mr. Coleman's coccyx dressing is soiled with feces. Another client, Mrs. Gale, 72 years old, requests a shower first thing as she has a dental appointment at 09 00 h. What should the practical nurse do first? 1. 2. 3. Assess Mr. Coleman's dressing. Shower Mrs. Gale. Change Mr. Coleman's dressing.

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Call to delay Mrs. Gale's dental appointment.

95. Jim, 16 years old, has just been admitted to hospital with a closed-head injury. Which one of the following neurological functions should the practical nurse assess first? 1. 2. 3. 4. Equality of hand grips Pupillary reaction Vital signs Level of consciousness

96. The nurse-in-charge asks the practical nurse to give Mr. Dacy a fleet enema. How should the practical nurse first proceed? 1. 2. 3. 4. Position the client on his left side. Check the chart to verify an order. Ask the client if he is constipated. Perform a rectal examination.

97. The practical nurse enters 68-year-old Mr. Salvo's room in the long-term care facility to perform his daily dressing change. The practical nurse finds the client in his wheelchair and ready to accompany his wife to the family room for meditation, which he does every other day. What should the practical nurse do? 1. 2. 3. 4. Reschedule the dressing change following the client's meditation session. Perform the dressing change as planned as quickly as possible to keep on schedule. Ask the client not to schedule meditation at this time of the day. Obtain an order to change the dressing every 2 days.

98. Mrs. Yee is receiving a narcotic for abdominal pain. What should the practical nurse do when administering this medication to Mrs. Yee? 1. 2. 3. 4. Keep the side rail of the bed up on Mrs. Yee's dominant side following administration. Plan activities for immediately following narcotic administration. Sign the narcotic control book for each dose administered. Assess Mrs. Yee's vital signs immediately following narcotic administration.

99. Suzy, 15 years old, has a fractured tibia. Yesterday, the physician ordered physiotherapy to teach crutch walking but the therapist has not arrived yet. What action should the practical nurse take? 1. 2. 3. Remind the physiotherapy department of the order for Suzy's ambulation. Teach Suzy the proper way to use the crutches and assist her with transferring. Call the nursing supervisor and inform her of the delay in Suzy's therapy.

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Ask for assistance from a co-worker to help ambulate Suzy with the crutches.

100. What is an indication that the practical nurse is working within the boundaries of the nurseclient relationship? 1. 2. 3. 4. Spends extra time with a client who is upset. Takes a client to a movie on a day off. Changes assignment to care for a specific client. Provides home phone number to a client who is lonely.