Kaplan PN Test 1 Study Set

Kaplan PN Test 1 Study Set ScienceMedicineNursing Annamarie_Rose9 Save PEARSON NCLEX-RN Questions & R...199 terms Candice_Haygood Preview Exam Cram NCLEX-PN PRACTICE Q...103 terms summer3266Preview Kaplan Nursing Entrance Exam (Scie...63 terms Emmyg1979Preview NCLEX Teacher Tut The LPN/LVN cares for a client with stomatitis due to chemotherapy. Which of the following actions should the LPN/LVN take FIRST?

• Examine the client's mouth for blisters, sores, or drainage.

2.Encourage the client to use a commercially prepared mouthwash twice daily.

• Instruct the client to use a soft-bristled toothbrush.
• Offer mouth care morning and night.

(1)CORRECT—first step of the nursing process is to gather data; examine client's mouth thoroughly every 4 hours; document size, character, and drainage (2)commercially prepared mouthwashes contain alcohol, which is drying to the mucous membranes; client should rinse with plain water or saline hourly (3)appropriate action, but should first assess (4)offer mouth care before and after meals

The LPN/LVN cares for an elderly client admitted with a diagnosis of hepatitis A. The client is anorexic, complains of weakness, is incontinent of urine, and involuntary of stool. The LPN/LVN determines that the nursing care is appropriate if which of the following is observed?

• Standard precautions are observed when caring for the client.
• The client is offered frequent feedings during afternoon and evening hours.
• The client is maintained on strict bedrest.

4.The client is placed on contact precautions.(1) transmitted via feces; fecal incontinence requires contact precautions (2) offer diet high in calories, with moderate amounts of protein and fat; clients more nauseated in afternoon and evening; offer majority of calories earlier in the day (3) alternate periods of rest and activity; especially important for elderly because they are more prone to developing complications from immobility (4) CORRECT—hepatitis A spread by fecal-oral route; contact precautions required due to fecal incontinence; instruct client in importance of good hand washing The LPN/LVN carries out a nursing care plan that includes helping a client to establish a regular exercise program. The LPN/LVN determines further teaching is required if the client makes which of the following statements?

• "I should choose an exercise that suits my lifestyle."
• "I should incorporate exercise into my daily routine."
• "I should make a commitment to exercise regularly."
• "I should start by running 5 miles every day."

(1)exercise should be a combination of aerobic exercise, stretching and flexibility exercise, and resistance training; previous lifestyle could be sedentary (2)should exercise 30 minutes or more a day for a total of 3 to 4 hours per week (3)daily exercise does not have to be done all at one time; can break the exercise into 10-minute segments (4)CORRECT—client should begin slowly; there are many health benefits to regular exercise of moderate intensity

Although a 51-year-old male sleeps 8 to 9 hours per night, he informs the LPN/LVN that he generally feels tired and has difficulty concentrating on job-related activities. Which of the following actions by the LPN/LVN is MOST appropriate?

• Contact the supervising nurse.
• Ask the client if he is having numbness and weakness of the extremities.
• Suggest the client take naps during the day.
• Determine if the client has been diagnosed with a sleep disorder.

Strategy: "MOST appropriate" indicates that discrimination is required to answer the question.(1) CORRECT—changes in sleep pattern commonly associated with depression; other indications include low self-esteem, feelings of helplessness/hopelessness, unkempt appearance, weight loss (2) fatigue related to inadequate rest is seldom associated with underlying physical disease (3) may cause sleep/wake cycle to be out of balance; if the sleep/wake cycle is out of balance, clients spend a longer period in the rapid eye movement (REM) phase and a shorter period in the deeper sleep phase; this results in an inadequate amount of rest; is commonly associated with depression (4) clients with sleep disorders usually awaken several times during the night The LPN/LVN makes a home visit to a client who complains of low back pain. Which of the following statements, if made by the client, requires follow-up by the LPN/LVN?

• "I work full-time as a checker at the local grocery store."
• "I sleep on a firm mattress."
• "I walk for 30 minutes each day."
• "I sleep on my side with my knees and hips flexed."

Strategy: "Requires follow-up" indicates that something is wrong.

(1.) CORRECT—clients with low back pain should avoid standing for prolonged periods of time; important to follow up on this statement by determining how long the client stands each day and how frequently the client is able to rest (2.) client with low back pain should sleep on a firm mattress or place boards between mattress and box springs for added support; lying on floor with feet elevated on bed or chair will also support back (3.) daily exercise is appropriate (4.) position that promotes good body mechanics

While working in the outpatient clinic, the LPN/LVN obtains a history from a client complaining of diarrhea. It is MOST important for the LPN/LVN to follow up on which of the following client statements?

1."I eat a lot of processed foods."2."I've been taking cephalexin for the last week." 3."I eat small meals four to six times per day." 4."I prefer to eat my food cold.(1) processed foods will not cause diarrhea (2) CORRECT— oral antibiotics given for infections may alter the natural flora of the GI tract; this change in normal flora, especially the lack of Lactobacillus, often causes diarrhea (3) small frequent feedings not a cause of diarrhea (4) cold foods will not cause diarrhea An elderly client with a fractured left hip is placed in Buck's traction. Because the client becomes disoriented to person, place, and time, the LPN/LVN expects to perform which of the following actions FIRST?

1.Obtain a sitter for the client.

2.Obtain a urine specimen for culture and sensitivity.

3.Contact the client's family.

4.Obtain the client's temperature.

Strategy: "FIRST" indicates priority.

(1.) LPN/LVN contributes information to the decision-making process; activity more likely to be performed by RN or social worker (2.) CORRECT—the elderly may become confused due to infection; UTIs are common; likely to notify health care provider, who will order collection of urine specimen (3.) family needs to be notified of the change in mental status; the most significant action would be aimed at resolving the problem (4.) because an elevated temperature may or may not accompany an infection in the elderly client, is not as likely to validate a UTI The LPN/LVN cares for a client after a total mastectomy of the right breast. The LPN/LVN should intervene if which of the following is observed?

1.The assistive personnel reports 75 ml of serosanguineous drainage in the Jackson-Pratt drain .2.The client requests analgesic medication.

3.The client flexes and extends the right wrist and fingers.

4.The assistive personnel obtains the client's blood pressure in the client's right arm every 4 hours.(1)drain in place to prevent fluid from collecting under the skin flaps; this amount of drainage does not indicate a complication; observe for hemorrhage (2)administer analgesic to prevent pain (3)prevents atrophy of muscles and contractures and will enhance fluid return (4)CORRECT—do not use affected arm to take blood pressure, draw blood, or give injections; elevate affected arm to decrease swelling and discomfort