Fundamental PN Hesi V2

1) During the initial physical assessment of a newly admitted client with

a pressure ulcer, a LPN observes that the client's skin is dry and scaly.

The nurse applies emollients and reinforces the dressing on the pressure

ulcer. Legally, were the nurse's actions adequate?

A The nurse also should have instituted a plan to increase activity.

B The nurse provided supportive nursing care for the well-being of the

client.

C Debridement of the pressure ulcer should have been done before the

dressing was applied.

D Treatment should not have been instituted until the health care

provider's prescriptions were received.

Correct Answer: B

2) A visitor comes to the nursing station and tells the nurse that a client

and his relative had a fight and that the client is now lying unconscious

on the floor. What is the most important action the LPN/LVN needs to take?

A Ask the client if he is okay.

B Call security from the room.

C Find out if there is anyone else in the room.

D Ask security to make sure the room is safe

Correct Answer: D

3) To ensure the safety of a client who is receiving a continuous

intravenous normal saline infusion, the LPN should change the

administration set every:

A 4 to 8 hours

B 12 to 24 hours

C 24 to 48 hours

D 72 to 96 hours

Correct Answer: D

4) A LPN/LVN is taking care of a client who has severe back pain as a result

of a work injury. What nursing considerations should be made when

determining the client's plan of care? Select all that apply.

A Ask the client what is the client's acceptable level of pain.

B Eliminate all activities that precipitate the pain.

C Administer the pain medications regularly around the clock.

D Use a different pain scale each time to promote patient education.

E Assess the client's pain every 15 minutes

Correct Answer: A, C

5) The LPN/LVN is preparing to administer eardrops to a client that has

impacted cerumen. Before administering the drops, the nurse will assess

the client for which contraindications? Select all that apply.

A Allergy to the medication

B Itching in the ear canal

C Drainage from the ear canal

D Tympanic membrane rupture

E Partial hearing loss in the affected ear

Correct Answer:A,C,D

6) What clinical indicators should the LPN/LVN expect a client with

hyperkalemia to exhibit? Select all that apply.

A Tetany

B Seizures

C Diarrhea

D Weakness

E Dysrhythmias

Correct Answer:C,D,E

7) A health care provider has prescribed isoniazid (Laniazid) for a

client. Which instruction should the LPN give the client about this

medication?

A Prolonged use can cause dark concentrated urine.

B The medication is best absorbed when taken on an empty stomach.

C Take the medication with aluminum hydroxide to minimize GI upset.

D Drinking alcohol daily can cause drug-induced hepatitis

Correct Answer:D