Book one Case Information CASE 1 Mr. Lamy, 62 years old, is hospitalized with emphysema.

He is receiving continuous oxygen therapy by nasal cannula. QUESTIONS 1 to 5 refer to this case 1. Mr. Lamy has just finished his bath when he presents with dyspnea. He sits down, leaning forward slightly. What should the practical nurse do? A. Increase Mr. Lamy's oxygen flow. B. C. D. Check the oxygen saturation level. Ask Mr. Lamy to take deep breaths. Encourage diaphragmatic breathing.

2. The next day, the practical nurse teaches Mr. Lamy how to perform breathing exercises for his emphysema. Which one of the following shows that Mr. Lamy has understood the teaching? A. Mr. Lamy observes his abdominal muscles when inhaling and exhaling. B. C. Mr. Lamy counts his respirations while inhaling and exhaling silently. While supine, Mr. Lamy inhales deeply and says the letter "O" on exhalation.

D. While sitting, Mr. Lamy inhales deeply and exhales slowly with pursed lips.
3. Which one of the following observations would indicate to the practical nurse the possibility of a respiratory tract infection?

A. Dyspnea and more frequent use of bronchodilators B. C. Increasingly laboured respirations with whistling on exhalation Reduced breath sounds and presence of tachypnea

D. A productive cough with purulent secretions 4. Mrs. Lamy asks for information on emphysema. Which one of the following pieces of information about emphysema is the most important to give Mrs. Lamy? A. Inform her that Mr. Lamy will have to limit his physical exertion. B. C. Encourage her to consult their physician for emphysema screening tests. Explain to her that Mr. Lamy will recover once the drug therapy begins.

D. Let her know that his lung tissue might regenerate if he were to stop smoking. 5. Mrs. Lamy is Aboriginal. She informs the practical nurse that she and her husband have asked an Aboriginal healer to visit Mr. Lamy. What should the practical nurse do? A. Inform them it is preferable that only one style of therapy be used at a time. B. C. Suggest a meeting between the attending physician and the healer. Discuss with the health care team how to accommodate this visit.

D. Do some reading on traditional Aboriginal beliefs.

END OF CASE 1 Case Information CASE 2 Mr. Robertson, 30 years old, was diagnosed 5 years ago with rapidly progressing multiple sclerosis. He has been married for 8 years and has two children, aged 7 and 5. He has recently been admitted to a longterm care facility because his wife can no longer care for him at home. QUESTIONS 6 to 9 refer to this case. 6. What behaviour would indicate to the practical nurse that the disease has progressed beyond its early stages?

A. Choking on solid foods B. Ataxic gait

C. Report of tingling in extremities D. Having periodic tremors in extremities 7. What procedure should the practical nurse implement when using a mechanical sling lift to move Mr. Robertson from his bed to a wheelchair? A. Instruct him to hold onto the swivel bar during transfer. B. C. Position the wheelchair perpendicular to the lift. Place the bed in the lowest position.

D. Ask a coworker to assist in the transfer.

8. Mr. Robertson's two sons visit frequently. Which one of the following responses should the practical nurse give when the 7-year-old son asks what is wrong with his dad? A. "Your dad has a disease called multiple sclerosis, which is a disease of the nervous system." B. C. "Your dad has problems with the way messages are sent from his brain to different parts of his body." "That's a very good question! You should ask your dad."

D. "Can you tell me what your mom or dad have told you about his illness?"
9. Which response by the practical nurse would be the most encouraging when Mr. Robertson indicates his desire to be more involved in his care? A. "Would you like to wash and shave yourself daily?" B. C. "We can help you with the goals that you set for yourself." "You can decide how long you would like to stay up in the wheelchair."

D. "I am glad you want to participate in your care." Case Information CASE 3

Sean is an 8-month-old infant who is fed via a gastrostomy tube. He is brought to the hospital with diarrhea and dehydration. QUESTIONS 10 to 15 refer to this case. 10. Sean's diarrhea has increased. Which sign exhibited by Sean should the practical nurse report immediately? A. Depressed fontanel B. C. Flushed face Heart rate of 110 beats/min

D. Respiratory rate of 34 breaths/min 11. What should the practical nurse do to maintain Sean's fluid intake? A. Administer the ordered electrolyte solution. B. C. Give high-glucose juices frequently. Administer larger quantities of the usual tube-feeding solution.

D. Give small amounts of milk at least once every hour. 12. Sean's rectal temperature is 37.5 C. He has also developed an irritated rectal area. Which one of the following should the practical nurse consider when planning Sean's morning bath? A. A tub bath would soothe his irritated skin. B. C. A bed bath should be performed to maintain the gastrostomy tube patency. A tepid sponge bath would decrease his temperature.

D. A bed bath should be performed to maintain medical asepsis. 13. Sean's gastrostomy tube site is leaking gastric contents. What should the practical nurse do to prevent irritation of the skin at the tube site? A. Apply minimal traction to the tube to prevent leakage. B. C. Maintain a central position of the tube in the opening. Protect the surrounding skin from drainage.

D. Cleanse the skin surrounding the tube daily. 14. Sean's mother is unable to visit for long periods, and Sean cries when she is not there. What should the practical nurse do to best communicate care and concern to Sean? A. Provide Sean with a cuddly teddy bear. B. C. Distract Sean with a colourful mobile. Stroke Sean's head and upper back.

D. Ask a volunteer to sit with Sean. 15. Sean is having fewer stools per day, and his hydration status is improving. Which documentation by the practical nurse would best indicate Sean's progress?

A. Two formed yellow stools, mucous membranes moist B. C. Less frequent stools, turgor improved over yesterday Stools small and partially formed, mucous membranes intact

D. Three less stools today, skin returns immediately after pinching 16. Mr. Whitney is 1 day postoperative and has a right leg cast. What priority postoperative assessments should the practical nurse perform? A. Pain, level of consciousness, intake and output, peripheral neurovascular status B. C. Vital signs, pain, intake and output, chest assessment, bowel sounds Pain, bowel sounds, level of consciousness, vital signs

D. Vital signs, pain, chest assessment, peripheral neurovascular status Case Information CASE 4 Mr. Whitney, 53 years old, is admitted to a surgical unit following an open reduction of a fractured right tibia resulting from a motor vehicle crash. QUESTIONS 16 to 20 refer to this case. 17. The practical nurse notes from the preoperative records that Mr. Whitney smokes. He is receiving narcotic analgesia. Which postoperative teaching would be most important? A. Range-of-motion exercises B. C. Incentive spirometry Adequate fluid intake

D. Activities of daily living 18. During care, Mr. Whitney states "I am worried I will become constipated." What is the most appropriate response for the practical nurse to make? A. "Don't worry. It is unlikely you will become constipated." B. C. "We can give you a suppository now if you think you need it." "We have a bowel protocol that will help you stay regular."

D. "Let us know when you are uncomfortable and we can give you a laxative." 19. Mr. Whitney rings the call bell and states, "My leg hurts more than before and feels numb." Upon assessment, the practical nurse notes pallor and coolness of the toes of the right foot. What should the practical nurse do? A. Elevate the affected extremity on pillows. B. C. Encourage range-of-motion exercises of the affected extremity. Make certain the physician is notified of the assessment findings.

D. Administer p.r.n. analgesic as ordered.

20. Mr. Whitney is preparing for discharge. He states, "I don't know how I will manage with my crutches as my home has many stairs." What should the practical nurse do? A. Give Mr. Whitney written instructions on how to use crutches and allow time for him to practise crutch walking prior to discharge. B. C. Provide a video demonstrating the correct technique and suggest he avoid using the stairs for a few days. Reinforce use of crutches, provide written instructions, and have Mr. Whitney demonstrate techniques prior to discharge.

D. Arrange for a physiotherapist to visit Mr. Whitney at home to provide crutch-walking instructions in the home environment. INDEPENDENT QUESTIONS QUESTIONS 21 to 100 do not refer to a case. 21. Mrs. Anderton, 42 years old, is awaiting transfer to another unit. While walking to the washroom, she feels dizzy and faints. After ensuring client safety, which action by the practical nurse is most appropriate? A. Chart as soon as possible after the incident. B. C. Chart incident after completing morning care. Complete incident report at the end of shift.

D. Report the incident to the registered nurse at shift change. 22. Mr. Desjarlais, 66 years old, has anemia and congestive heart failure. He is receiving three units of packed cells over 8 hours. Which of the following assessments would indicate a complication related to the rate of transfusion for Mr. Desjarlais? A. Visible pulsations of the aorta in the lower abdomen B. C. Urticaria on lower legs and across anterior chest Generalized fatigue and nausea verbalized

D. Crackles noted on auscultation of lungs 23. While on rounds at the nursing home, a practical nurse observes a colleague reprimand a client. Which nursing intervention must the practical nurse perform? A. Call the colleague aside and suggest that the client deserves an apology. B. C. Report the incident to a supervisor immediately and document. Ask the colleague why the client was reprimanded and document the response.

D. Reassure client and discuss the reprimand incident with the colleague. 24. Mary, 12 months old, has been admitted to a pediatric unit with an acute asthma attack. Upon assessment, the practical nurse notes bruises in various stages of healing. What should the practical nurse do next? A. Inform the nurse-in-charge.

B. C.

Notify child protection services. Discuss in shift report.

D. Talk with a coworker. 25. The practical nurse is caring for a 69-year-old immobile client with a large pressure ulcer on the coccyx. The dressing change is ordered b.i.d. This morning, a small area of the dressing is soaked. What is the best intervention for the practical nurse to take? A. Request an order for an increase in the frequency of dressing changes. B. C. Place incontinence briefs on the client and put extra pads on the bed. Apply plastic tape over the dressing to prevent leaking.

D. Proceed with the dressing change and apply extra gauze. 26. Mrs. Wong, 91 years old, suffered a stroke many years ago and requires a geriatric chair when out of bed. How should the practical nurse position Mrs. Wong in this chair? A. In lateral position, supported with a pillow against her back B. C. In semi-Fowler's position with her affected side supported by pillows In an upright position with pillows under her feet

D. In supine position, with her affected hand positioned with a splint 27. Ms. Toth, 45 years old, had a knee replacement and has one unit of whole blood transfusing. Which finding would indicate an adverse reaction? A. Chills, fever and flushing of face B. C. Hypoxia, tachypnea and tachycardia Dyspnea, tachypnea and chest pain

D. Jaundice, ascites and edema 28. While 73-year-old Mr. Brown is being admitted to his room in the nursing home, he notices his roommate being rushed to the hospital. Mr. Brown asks about the health of his new roommate. How should the practical nurse respond? A. "You can ask your new roommate about his condition when he returns." B. C. "I can appreciate your concern, but I need to complete your admission." "I can see you're worried, but I can't share any client information without permission."

D. "Your roommate has been ill for a long time and had to be admitted to the hospital." 29. Mr. Branch, 67 years old, is diagnosed with prostate cancer and is worried about his future. He has had a colostomy for many years, has difficulty voiding, and does not sleep well. Which one of the following nursing interventions should be included in his plan of care? A. Arrange for a private room to help him sleep. B. Perform a catheterization to measure residual urine.

C.

Ask a clergy member to visit so he can verbalize his feelings.

D. Offer him the opportunity to express his concerns further. 30. Mr. Gosling, 37 years old, was admitted to the medical ward 2 days ago with cellulitis of his left arm. Mr. Gosling has never been in hospital before and is unsure of what to expect. How should the practical nurse involve the staff and Mr. Gosling in planning care? A. Ask Mr. Gosling how he would like his care performed. B. C. Schedule a team conference to include Mr. Gosling. Discuss Mr. Gosling's care in the change of shift report.

D. Develop a care plan using information from Mr. Gosling. 31. While monitoring a blood transfusion, the practical nurse assesses the vital signs and notes that the client's temperature has gone from 37.2 to 38.5 C. The client is experiencing no other symptoms. What is the most appropriate action by the practical nurse to take? A. Continue monitoring for other symptoms. B. C. Notify the team leader to discontinue the transfusion. Notify the physician immediately.

D. Encourage the client to drink extra fluids. 32. Mr. Grimstead, 78 years old, is admitted to the hospital with pneumonia. He is accompanied by his daughter who cares for him. Mr. Grimstead tells the practical nurse, "I'm not really sick enough to be here. I just have a little cough." How should the practical nurse initially plan his nursing care? A. Discuss Mr. Grimstead's care with his daughter. B. C. Request an interdisciplinary conference to develop the care plan. Involve Mr. Grimstead in determining goals of care.

D. Review the standardized care plan for a client with pneumonia. 33. David, 4 years old, fell while running with a pair of scissors. After hearing the cries for help, the practical nurse arrives to find David on the floor with the scissors in the left side of his chest with no visible bleeding. What is the most important fact about a puncture wound for the practical nurse to consider at this time? A. Removal of the scissors could start uncontrolled bleeding. B. C. Bleeding from the puncture wound will remove microorganisms. Pressure should be exerted on the wound to control bleeding.

D. Elevating the head will prevent hypovolemic shock. 34. Mr. Martin, 70 years old, is sitting in an armchair that is too low for him. How should the practical nurse promote Mr. Martin's comfort and correct body alignment? A. Have him stand, and place a pillow on the seat of the chair. B. Have him sit forward, and place a pillow behind his back.

C.

Make a note on the nursing care plan that his chair is not suitable.

D. Elevate his feet on a footstool. 35. The practical nurse is about to perform perineal care on Mr. Wall. What should the practical nurse do initially to demonstrate respect for Mr. Wall? A. Provide privacy for him. B. C. Demonstrate competence in performing the procedure. Ask him to perform the procedure.

D. Adhere to the principles of medical asepsis. 36. Mrs. MacDonald, 34 years old, delivered a baby 1 day ago. Which of the following findings would indicate that the client is at risk for hemorrhage? A. Firm fundus and foul-smelling lochia B. C. Soft fundus positioned to the left of the umbilicus Lochia rubra contains small clots

D. Heavy lochia flow when first standing up 37. Mrs. Stein, 39 years old, had a hysterectomy yesterday. Her employer has stopped by the unit to visit but finds her sleeping. The employer asks, "Will Mrs. Stein be discharged tomorrow?" How should the practical nurse respond? A. "If Mrs. Stein is a typical hysterectomy client, she will stay in hospital for at least 2 days." B. C. "You should ask Mrs. Stein that question when she wakes up." "I don't think it is appropriate for you to ask that question about Mrs. Stein."

D. "With earlier discharges, Mrs. Stein should go home this evening." 38. Mr. Napolski, 78 years old, has Type I diabetes mellitus. The practical nurse mistakenly provides him with another client's meal. Which action best indicates that the practical nurse has assumed accountability? A. Monitors for an adverse reaction. B. C. Adjusts Mr. Napolski's diet. Reports the incident.

D. Documents tolerance of the meal. 39. A client's intravenous therapy is to be discontinued. Which is the most appropriate action for the practical nurse to take to remove his IV? A. Apply pressure, clamp IV, loosen tape, glove, and remove cannula. B. C. Clamp IV, glove, loosen tape over site, remove cannula, and apply pressure with gauze. Loosen tape over site, obtain alcohol swab, glove, remove cannula, and apply pressure.

D. Clamp IV, obtain gauze, loosen tape over site, glove, and remove cannula.

40. A resident on an Alzheimer unit is periodically verbally and physically aggressive toward other residents and staff. What should the practical nurse, as the case manager, do? A. Call the resident's family and have a conference about the resident's aggressive behaviour. B. C. Encourage frequent rest periods for the resident and provide soothing music. Have the staff observe and document the resident's behaviour over a 1-week period.

D. Contact the resident's physician and obtain an order for a sedative to be given p.r.n. 41. When giving a medication to a 46-year-old male client by the intramuscular route in the deltoid site, what is the maximum volume that can be administered in one injection? A. 0.5 ml B. C. 1.0 ml 2.5 ml

D. 3.0 ml 42. Which one of the following describes auscultation? A. Listening to body sounds produced by the heart, lungs, and abdomen using a stethoscope B. C. Visually examining body parts using an otoscope and an ophthalmoscope Tapping the body with fingertips to help identify location, size, and density of underlying structures

D. Using touch to assess tenderness, texture, temperature, moisture, and organ location 43. Mr. Jenkins, 28 years old, is admitted for surgery and is reluctant to take pain medication due to a previous drug addiction. How should the practical nurse address this issue? A. Administer pain medication as ordered. B. C. Discuss potential of addiction with short-term pain management. Encourage use of pain medications.

D. Explain the consequences of unmanaged pain in the healing process. 44. The practical nurse is preparing medications for clients on a busy gerontological unit. Two clients have wandered into the medication room and a family member is requesting to speak to the practical nurse. What should the practical nurse do? A. Concentrate carefully on the medication orders. B. C. Take the family member and the clients to another room and speak with them. Escort the two clients out of the room and ask the family member to come back later.

D. Ask the two clients to remain quiet while the medications are being prepared. 45. Mrs. Armstrong, 72 years old, has no family but feels a special bond with the practical nurse. She asks if the practical nurse could visit on days off. How should the practical nurse respond? A. Agree to occasional visits with Mrs. Armstrong on days off.

B. C.

Explain to Mrs. Armstrong that visits are possible at work but not on days off. Tell Mrs. Armstrong that visiting on days off is not encouraged.

D. Request that the nurse-in-charge discuss the situation with Mrs. Armstrong. 46. A mechanical lift is needed to transfer an 85-year-old dependent male client. Before using the mechanical lift, which one of the following measures is most important for the practical nurse to consider? A. Have a second staff member available to assist with the transfer if necessary. B. C. Ensure that all the hooks or straps are in place before beginning the lift. Be familiar with the mechanical lift and how it functions.

D. Have the client centred on the lift so there is no risk of injury. 47. Mrs. Jabour is receiving a vasodilator. Which of the following clinical manifestations should the practical nurse report immediately? A. Orthostatic hypotension B. C. Blurred vision Decreased appetite

D. Dry mouth and constipation 48. Mrs. Kraemer, 67 years old, has chronic obstructive pulmonary disease and is receiving oxygen therapy via nasal cannula. What should the practical nurse do first? A. Verify the oxygen flow rate is as ordered. B. C. Ensure the humidification container has sufficient water. Check the positioning of Mrs. Kraemer's nasal cannula.

D. Observe Mrs. Kraemer's nares for skin or mucous membrane breakdown. 49. Which action by the practical nurse is the most appropriate before administering digoxin (Lanoxin)? A. Take the radial pulse for 30 seconds. B. C. Take the apical pulse for 1 minute. Check the blood pressure.

D. Check the vital signs. 50. Mr. Roads, 66 years old, has just been informed that he has tested positive for human immunodeficiency virus (HIV). Which one of the following responses by the practical nurse would demonstrate emotional support for Mr. Roads? A. "Most people with HIV continue to work for many years." B. C. "Everyone is at risk to contract this virus." "Would you like me to sit with you for a while?"

D. "Would you like some informative pamphlets to read?" 51. Which one of the following positions is most appropriate for the adult client when the practical nurse is administering a cleansing enema? A. Prone B. C. Dorsal recumbent Left Sims' position

D. Right, side-lying 52. Erin, a 16-year-old client with inflammatory bowel disease (IBD), requires more teaching prior to her discharge. Two of her friends are present and anxious to drive her home. What should the practical nurse do? A. Encourage support by including Erin's friends in the teaching. B. C. Suggest Erin contact the local IBD support group. Provide Erin with appropriate pamphlets to read at home.

D. Ask the friends to leave the room prior to speaking with Erin. 53. The practical nurse is informed by the team leader that Mrs. Knight needs her intravenous solution changed to normal saline at 125 ml/h. Which one of the following actions is most appropriate for the practical nurse to take? A. Change the intravenous solution and infusion rate immediately. B. C. Check the new order and then change the solution when the bag is empty. Obtain the new solution bag and prepare to hang the new infusion.

D. Verify the new order and then change the solution and confirm the rate. 54. While assisting Mr. Forache, 82 years old, the practical nurse finds that his anti-embolic stockings are more difficult to apply. He receives digoxin (Lanoxin) and furosemide (Lasix) daily. Which of the following interventions would be most appropriate for the practical nurse to take? A. Weigh Mr. Forache daily and document the finding. B. C. Apply the stockings after the digoxin has been administered. Lower both of his legs prior to applying the stockings.

D. Measure both of his calves and order new stockings. 55. Mr. Smith, 72 years old, lives independently. While making an initial home visit, the practical nurse notes that Mr. Smith has poor personal hygiene and his house is untidy and dirty. How can the practical nurse best respond to the situation? A. "You are having difficulty taking care of yourself and your home. Would you consider going to a long-term care facility?" B. "A lot of seniors live at home with community support services. Why don't you look into one of these services?"

C.

"I am concerned about you living alone. Do you have neighbours who could assist you regularly?"

D. "Many community services are available. Would you like some assistance with information and contacts?" 56. An adult client is receiving intravenous therapy of normal saline (0.9%) via a peripheral line. Which statement by the practical nurse is correct? A. "The intravenous administration sets are changed every 48-72 hours." B. C. "Check physician's orders every 4 hours." "Assess the client's intravenous therapy every 2 hours for rate of flow and level of fluid."

D. "The intravenous solution bag should be changed when there is 100-200 ml remaining." 57. The practical nurse is preparing Mrs. Kailha, a 68-year-old Hindu client, for a chest x-ray. She is dressed in a traditional sari and refuses to disrobe and wear a hospital gown. What is the most appropriate information the practical nurse should give Mrs. Kailha? A. She must change into the gown or the x-ray cannot be completed. B. C. Her need to maintain dignity is understood but the sari must be removed. She may wear her sari as long as it does not interfere with the x-ray.

D. Her concerns are understood; the x-ray will have to be cancelled. 58. The practical nurse overhears a colleague speaking loudly and abruptly to a client. The client requests that the practical nurse assume care for her for the remainder of the shift. What should the practical nurse do? A. Inform the colleague of the client's request and volunteer to take on this assignment. B. C. Let the colleague know that the interaction was overheard and discuss the situation further. Empathize with the client and indicate that it will be discussed with a supervisor.

D. Inform the nurse-in-charge of the client's request and ask for a change of assignment. 59. When checking a client's IV infusion, the practical nurse notes that the flow rate is decreased, there is swelling at the IV site, and the area feels cold to touch. The client describes tightness and a burning sensation at the site. Which one of the following actions should the practical nurse perform first? A. Check the site every 15 minutes. B. C. Apply warm compresses. Stop the infusion.

D. Apply cold compresses. 60. Which behaviour by the practical nurse is considered professionally responsible? A. Performing all nursing duties as asked B. Reporting accidents or errors at the end of shift

C.

Showing respect to employer and coworkers

D. Restricting personal calls at the nursing unit 61. A client begins sneezing and becomes short of breath following administration of an antibiotic. What should the practical nurse do? A. Ring the emergency call bell and assess the client's vital signs. B. C. Go immediately to the nursing station to contact the physician. Lower the head of the bed and obtain the emergency cart.

D. Raise the head of the bed and start oxygen. 62. Mr. Olsen, 21 years old, has developed a staphylococcal wound infection following abdominal surgery. Which is the most important action for the practical nurse to do when providing care? A. Teach the client to keep his hands away from his dressing. B. C. Use gloves when removing his soiled dressing. Ask visitors to wear a gown when visiting him.

D. Wear gown and mask when changing his dressing. 63. Mrs. Brar, 68 year old, states she has ongoing pain in her left lower leg following exercise. Initial assessment reveals mottled, cool skin and decreased pedal pulses. What might be the cause of these symptoms? A. Arterial insufficiency B. C. Deep vein thrombosis Venous insufficiency

D. Arterial thrombosis 64. An adolescent male has been prescribed ampicillin (Ampicillin) 250 mg p.o. q.i.d. He tells the practical nurse that he once had a pill that colour which made him feel sick. What initial action should the practical nurse take? A. Ask a physician for an order for an antiemetic. B. C. Administer the medication with food. Have a physician perform an intradermal test.

D. Withhold the medication. 65. Which one of the following actions by the practical nurse would best ensure sterility when changing an IV solution bag? A. Pull the spike from the bag without touching the tip. B. C. Wear sterile gloves when changing the IV bag. Remove the seal from the replacement solution bag.

D. Cleanse the tip of the IV tubing with an alcohol swab.

66. Mrs. Harris, 72 years old, is receiving an intramuscular injection of meperidine hydrochloride (Demerol). Upon aspiration, blood appears in the syringe. What should the practical nurse do next? A. Discard and draw up meperidine hydrochloride into a new syringe. B. C. Withdraw the needle, remove the blood, and inject into another site. Pull the needle up 0.5 cm and aspirate again.

D. Withdraw the syringe and inject using a shorter needle. 67. Mr. Johnson has internal and external hemorrhoids. In preparing Mr. Johnson for the application of a rectal cream, the practical nurse finds the perineal pad soaked with fresh blood. Which approach is most appropriate for the practical nurse to take? A. Cleanse the area and apply cream as ordered. B. C. Apply an ice pack to reduce bleeding. Withhold the cream and inform the team leader.

D. Apply a clean perineal pad following application of the cream. 68. When the practical nurse is changing an IV bag/bottle, what is the optimum level of fluid that should be maintained in the drip chamber to prevent air from entering the tubing? A. One-quarter full B. C. Half full Three-quarters full

D. Full 69. Mrs. Drake, 19 years old, is admitted to the hospital with acute abdominal pain. Which one of the following questions by the practical nurse best assesses Mrs. Drake's pain? A. "Mrs. Drake, can you describe your pain for me? Do you know the 0 - 10 pain scale?" B. C. "How is your pain? Is there anything else that I can get for you now?" "When did your abdominal pain start? Could you tell me if your pain is sharp or dull?"

D. "Mrs. Drake, I see you are smiling now. Is your pain medication working?" 70. The practical nurse is providing morning care to Ms. Langlois, 83 years old, a resident in a long-term care facility. Ms. Langlois tells the practical nurse, "I am useless. I want to die." Which communication technique should the practical nurse use initially? A. Sympathy B. C. Clarification Silence

D. Distraction 71. Mrs. Schwartz, 70 years old, has been admitted with anemia. She has a history of chronic congestive heart failure. Two hours into her blood transfusion, Mrs. Schwartz develops a dry cough. What should the practical nurse do?

A. Discontinue the transfusion, sit her upright, monitor vital signs closely, and report. B. C. Continue the transfusion, assess her breathing, collect sputum for culture and sensitivity, and document. Stop the transfusion, have her deep breathe and cough, check her oxygen saturation, and document.

D. Slow the flow rate of the blood transfusion, monitor vital signs, report, and document. 72. Which one of the following terms best describes an expected response to a diuretic medication? A. Anuria B. C. Polyuria Dysuria

D. Pyuria 73. Mrs. Porter has been on bedrest for 2 days. The practical nurse observes an area on her coccyx that is reddened but intact. Which is the best intervention to include in the plan of care? A. Cover the site with a protective dressing. B. C. Reposition every 2 hours. Apply a sheepskin to the bed.

D. Massage around the site briskly. 74. Mrs. Acker, 70 years old, has just been admitted to the hospital. Upon entering her room, the practical nurse finds her sitting on her bed crying. Which of the following actions by the practical nurse shows the appropriate use of touch in communicating care and concern to the client? A. Sit in front of Mrs. Acker and pat her gently on the knee. B. C. Stand beside Mrs. Acker and rub her back. Sit beside Mrs. Acker and touch her arm.

D. Stand beside Mrs. Acker and put an arm around her shoulder. 75. Of the following, what is the most important information found on the IV administration set package? A. Instructions for use of roller clamp to control the rate B. C. Instructions for height of container as it affects the rate Identification of the drop factor to be used to calculate the rate

D. Identification of the formula to be used to calculate the rate 76. How should the practical nurse proceed when administering ear drops to an adult? A. Cleanse the internal auditory canal. B. C. Pull the pinna downward and back. Ask the client to lie down for 15 minutes.

D. Pull the pinna upward and back. 77. A 13-year-old boy is admitted to hospital for treatment of partial thickness burns to both legs. He is eating small amounts. What food would be appropriate to serve this client? A. Jell-O with whipped cream B. C. Chicken soup with crackers High-protein shake

D. Two scoops of ice cream with bananas 78. Wendy, 12 years old, and her parents express concern about possible adverse effects from immunization. What should the practical nurse do? A. Reassure the family that their concerns will be documented. B. C. Suggest that the family speak with the physician about their concerns. Explain that there is much misinformation about immunizations.

D. Listen to concerns, answer questions, and provide factual information. 79. Pat is a practical nurse working in a long-term care facility. When transferring a client with Alex, a co-worker, Pat smells alcohol on Alex's breath. What should Pat do first? A. Report the incident to the nurse-in-charge. B. C. Wait and see if, on another day, Alex's breath still smells of alcohol. Ask another coworker, "Does Alex have an alcohol problem?"

D. Approach Alex and say, "I smell alcohol on your breath." 80. While making rounds, the practical nurse notices that Mrs. Brown's parenteral nutrition infusion tubing was not dated. Which action is most appropriate to take? A. Check the chart to determine when the tubing was last changed. B. C. Take the necessary steps to have the tubing changed. Report to the team leader that the tubing was not dated.

D. Ask Mrs. Brown when the tubing was changed last. 81. Carol, 16 years old, was recently diagnosed with Type II diabetes mellitus and is very unhappy with the dietary restrictions. When Carol's tray comes at lunch time, she refuses to eat. What should the practical nurse do to assist Carol? A. Take the tray away and say nothing, respecting the teenager's need for independence. B. C. Call the kitchen and request that an alternative meal be sent. Tell Carol that it is important that she eat all the food on her tray.

D. Ask Carol what she would like to eat now, and request a prompt dietary consult. 82. ason, 10 years old, has not voided since returning from the operating room 6 hours ago, following an appendectomy. What should the practical nurse do first?

A. Palpate Jason's lower abdomen above the symphysis pubis. B. C. Encourage Jason to drink more fluids. Inform the physician that Jason has not voided.

D. Tell Jason that he needs to void or a catheter will be inserted. 83. The practical nurse notices a new order for normal saline (0.9%) IV. The practical nurse realizes that this order is incomplete. What information is necessary to implement the new IV order? A. Amount in the infusion bag. B. C. Bolus amount to be administered. Rate of infusion required.

D. Duration of the IV therapy. 84. Mrs. Jeffreys, 72 years old, is attending a preoperative clinic for health teaching. Mrs. Jeffreys states that she is glad her surgery date has been "moved up" so she can return to her volunteer activities. The practical nurse observes that Mrs. Jeffreys' movements are slow, she carefully feels the chair before she sits down, and she is reluctant to review the written information. Which area should the practical nurse assess more closely during her teaching session? A. Interest level B. C. Tactile changes Visual changes

D. Energy level 85. Mr. Stetson, a 31-year-old obese client, has pericarditis. He is receiving an antibiotic by intramuscular injection. How should the injection be administered? A. Needle length 1.5 inch with #18 gauge administered in the vastus lateralis muscle B. C. Needle length 1.5 inch with #21 gauge administered in the deltoid muscle Needle length 2 inch with #18 gauge administered in the dorsogluteal muscle

D. Needle length 2 inch with #21 gauge administered in the ventrogluteal muscle 86. Which observation should the practical nurse report for a postpartum client who delivered 12 hours ago? A. Firm fundus B. C. Fundus in median position Atonic fundus

D. Fundus at umbilicus 87. Mrs. Fraser, 84 years old, recently moved into the care facility after hip surgery. She is afraid of falling and frequently refuses to stand. What should the practical nurse do? A. Encourage Mrs. Fraser to walk independently with a walker.

B. C.

Reassure her that it is unlikely that she will fall again. Assist Mrs. Fraser to walk for 15 minutes a day.

D. Help her to walk each day, gradually increasing the distance. 88. Mrs. Chan, 68 years old, has a healing venous stasis leg ulcer. What should the practical nurse instruct the personal care aide to monitor and report? A. Changes in the size of the ulcer B. C. Characteristics of any drainage Blanching of the affected leg

D. Alteration of peripheral pulses 89. Mrs. Robinson has anemia and requires a blood transfusion. Fifteen minutes after the start of the transfusion, Mrs. Robinson reports that she has a headache, feels anxious, and is cold. What should the practical nurse do first? A. Check Mrs. Robinson's vital signs. B. C. Verify that the correct blood is transfusing. Notify the nurse-in-charge.

D. Offer Mrs. Robinson an analgesic. 90. Joanne, 8 years old, is hospitalized with cerebral palsy. During admission, the mother mentions that Joanne cannot remain seated for more than 30 minutes at a time, otherwise she becomes too tired and cries. What should the practical nurse do? A. Explain that it is preferable for Joanne to remain seated for a longer period. B. C. Take measures to integrate the mother's concerns into the care plan. Inform the mother that the workload may not make this request possible.

D. Ask if she would participate in Joanne's transfers while visiting. 91. Mr. Beanland, 65 years old, has been diagnosed with hypertension and atherosclerosis. What suggestion by the practical nurse should encourage Mr. Beanland to learn more about his disease? A. Attend a hypertension support group. B. C. Participate in the "Jump Rope for Heart" program. Review an information sheet on his medication.

D. Check his blood pressure at a local pharmacy. 92. The practical nurse arrives on the nursing unit and is receiving shift report. The Emergency Department nurse is requesting an immediate transfer of a 65-year-old client. A visitor in room 212 states, "My mother just fell." A physician arrives requesting immediate help with a dressing. How should the practical nurse proceed? A. Accept the 65-year-old client to the unit. B. Complete the dressing with the physician.

C.

Attend to the client who fell.

D. Finish the nursing unit shift report. 93. mother brings her 3-month-old female infant into the Well Baby Clinic stating, "She has not been feeding well." On examination of the baby, the practical nurse notes bruising on extremities and buttocks. What should the practical nurse do first? A. Report this suspected case of child abuse to the local authorities and the physician. B. C. Ask the mother about the child's bruises and gather further data about the situation. Inform the physician of the bruises and complete an incident report.

D. Notify social work and request a home assessment. 94. Mrs. Meyers, 57 years old, has end-stage liver disease and is being admitted to a health care facility from home. She is disoriented and unable to communicate her usual routine. What should the practical nurse do to develop a care plan? A. Use a standardized nursing care plan. B. C. Wait until she becomes re-orientated so she can be involved. Request input from her family and home care providers.

D. Ask for an immediate multidisciplinary team conference. 95. Mrs. Goshe, 71 years old, has been ordered a Mantoux test. How would the practical nurse best determine who is permitted to administer this test? A. Check with the professional association. B. C. Check the institutional policies and procedure. Check the provincial standards of practice.

D. Check with a colleague 96. What must a practical nurse do in order to work as a licensed/registered practical nurse in Canada? A. Be registered with a provincial/territorial licensing body. B. C. Pass the national licensing examination. Apply for registration/licensure as a practical nurse.

D. Graduate from a recognized practical nursing program. 97. A practical nurse is assigned a client who requires a Foley catheter removal. The practical nurse has been taught the skill but has not had the opportunity to practice it. After verifying the physician's order, what should the practical nurse do? A. Check a nursing skills text and then remove the catheter. B. C. Observe an experienced practical nurse remove the catheter. Discuss the procedure with the nurse-in-charge prior to removing the catheter.

D. Review the procedure manual and ask another nurse to observe the catheter removal. 98. The practical nurse obtains a temperature of 35.8 C when assessing the vital signs of a 1-dayold newborn. The practical nurse takes the temperature again and obtains the same result. What should the practical nurse do next? A. Record the temperature and proceed with the assessment. B. C. Warm the infant and take the temperature in 15 minutes. Press the emergency bell for assistance.

D. Contact the physician and report the temperature. 99. Mr. Simpson, 75 years old, recently had a cerebrovascular accident with extensive muscle paralysis. What should be included in Mr. Simpson's care plan? A. Position a footboard on his bed to prevent dorsiflexion of both feet. B. C. Use a trochanter roll to prevent external rotation of the leg. Put an eggcrate mattress to minimize interruptions in sleep by frequent turning.

D. Place a hip abduction wedge between his legs to prevent internal rotation. 100. How could the practical nurse best maintain sterility when changing a client's IV bag? A. Keep spike in sight when inserting it into the IV bag. B. C. Tape the administration set to the IV pole while hanging the new IV bag. Replace the IV solution bag while the drip chamber is empty.

D. Change the IV solution bag at least every 48 hours.