PN Comprehensive Online Practice 2020 A Questions and Answers (Verified Answers)
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PN Comprehensive Online Practice 2020 A
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PN Comprehensive Online Practice 2020 A
PN Comprehensive Online Practice 2020 A Questions and Answers (Verified Answers)
A nurse is reinforcing teaching with a client who is to self-administer epoetin alfa. Which of the following
instructions should the nurse include?
administer the medication subcutaneously.
A nurse enters the roo...
pn comprehensive online practice 2020 a questions and answers verified answers a nurse is reinforcing teaching with a client who is to self administer epoetin alfa which of the following instructi
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PN Comprehensive Online Practice 2020 A Questions and
Answers (Verified Answers)
A nurse is reinforcing teaching with a client who is to self-administer epoetin alfa. Which
of the following
instructions should the nurse include?
administer the medication subcutaneously.
A nurse enters the room of an adolescent client and finds them on the floor
experiencing a tonic-clonic seizure. Which of the following actions should the nurse take
when the seizure subsides?
keep the client in a side-lying position.
rationale: the nurse should keep the client in a side-lying position to facilitate drainage of
any secretion and prevent aspiration
A nurse is caring for a client who is in the final stages of cancer. Which of the following
client situations should the nurse identify as an ethical dilemma?
the client asks the nurse to help them die peacefully in their sleep.
rationale: the situation presents and ethical issue for the nurse because the client is
asking for a variation of active euthanasia, also known as assisted suicided, which is in
violation of the code of ethics for nurses. The nurse is legally and ethically unable to
support this decision by the client and should ask for assistance with this dilemma.
A nurse is caring fur a client who has a phobia elevators, Which of the following should
me nurse recognize as an indication of a positive client response to systematic:
desensitization?
the client remains relaxed when thinking about the phobia.
rationale: The purpose of desensitization therapy is to teach the client to use relaxation
techniques to overcome the anxiety caused by the phobia The nurse should recognize
the clients lack of anxiety when thinking about the phobia as a positive response to
the therapy.
A nurse is checking the reflexes of a newborn. Which of the following techniques should
the nurse use to elicit the Babinski reflex?
Stroke the sole of the newborn's foot upward and toward the great toe.
A nurse is reviewing the laboratory report of a client who is 2 days postoperative
following thoracic surgery. Which of the following laboratory results should the nurse
report to the provider?
WBC 25, 000 mm
rationale: The nurse should identify a WBC count of 25,000/mm3 is above the expected
reference range and is an indication that the client might have a postoperative infection;
therefore, the nurse should report this finding to the provider.
A nurse in an urgent care clinic is completing a client examination. After listening to the
client's lungs, which of the following adventitious sounds should the nurse document?
(Click on the audio button to listen to the clip.)
,wheeze
[audio]
rationale: the nurse should document this sound as a wheeze. A wheeze is a high
pitched musical sound that is heard when air moved through narrowed airway during
either inspiration or expiration.`
A nurse is preparing to administer an 1M immunization to a preschooler. Which of the
following statements should the nurse plan to make prior to performing the injection?
lets give the medication to your doll first.
A nurse is reviewing the medical record of a client who is receiving warfarin and has
atrial fibrillation. Which of the following laboratory values should the nurse report to the
provider?
INR 5.0
rationale: The international normalized ratio (INR) is a measurement of the body's blood
clotting ability. A client receiving warfarin to prevent clot formation related to atrial
fibrillation should have an INR of 2.0 to 3.0. An INR of 5.0 or greater indicates that the
client is at risk for bleeding. Therefore, the nurse should notify the provider about this
laboratory value.
Why PT of 18 is wrong: rationale The prothrombin time (PT) is a measurement of the
body's blood clotting ability. A prolonged PT is an indication of prolonged bleeding. A
client receiving warfarin to prevent clot formation related to atrial fibrillation should have
a PT of 1.3 to 1.5 times the control of 11.0 to 12.5 seconds. The client's PT is 1.4 times
the control value of 12.5 seconds. Therefore, the nurse does not need to report this
value to the provider.
A nurse is caring for a client who is scheduled for peritoneal dialysis. Which Of the
following actions should the nurse take first?
ensure the dialysate solution is at room temperature,
rationale: Evidence-based practice indicates the nurse should administer the dialysate
solution at a temperature of 37' C (98.6' F); therefore, the first action the nurse should
take is to warm the prescribed solution.
A nurse is reviewing the critical pathway of a client who is 4 days postoperative
following a total knee arthroplasty. The client's vital signs are oral temperature 39.10 C
(102.40 F), heart rate 116/min, respiratory rate 24/min, and blood pressure 152/92 mm
Hg. Which of the following actions should the nurse take?
document the finding as a variance.
rationale: Whenever a client does not meet the goals or outcomes in the critical pathway
due to unexpected findings or a need for additional interventions. the nurse should
document the details as a variance in the critical pathway. In this case. it is a negative
variance. If the client progresses faster than the pathway specifies, it is a positive
variance.
, A nurse is performing a dressing change for a client who is 3 days postoperative. Which
of the following findings should the nurse report to the provider?
Yellow green drainage at the incision line.
rationale: Yellow green purulent or odorous drainage indicates the wound is infected.
the nurse should report this finding.
rationale 2: pink incision line with slight crusting, serosanguineous drainage on the old
dressing, slight swelling around staples- are all expected finding for the client
A nurse is inspecting the skin of a newborn. Which of the following findings should the
nurse report to the provider?
Generalized petechiae
rationale: Petechiae are an expected finding over the presenting part of the newborn,
such as on the forehead in a brow presentation, and also anywhere on the head of
newborns who had a nuchal cord, which is an umbilical cord around the neck. However,
petechiae all over the newborn's body can indicate infection or a decreased platelet
count and should be reported to the provider.
A nurse is caring for a client who is recovering from a stroke and is experiencing
difficulty using eating utensils. The nurse should identify the need for a referral to which
of the following interprofessional team members?
Occupational therapist.
rationale: to teach client how to use special eating utensils.
A nurse is assisting with a discussion about STIs with a group of adolescents at a health
fair. Which of the following statements should the nurse make?
an infection with gonorrhea can result in infertility.
rationale: gonorrhea can lead to PID and tubal scarring which can result in infertility in
female clients.
A nurse in an outpatient surgery center is reinforcing discharge teaching with a client
following a lithotripsy for uric acid stones. Which of the following instructions should the
nurse plan to include in the teaching?
strain the urine to collect stone fragments.
rationale: The client should verify passage of the stones by straining their urine.
Laboratory analysis of the stones can provide information to help prevent future stone
formation.
A nurse is assisting with the transfer of a client to a long-term care facility. The nurse
should review which of the following sections of the electronic health record to locate
information about the client's personal health insurance?
admission sheet
A nurse is preparing to perform a bladder scan for a client. Which of the following
actions should the nurse take?
Tell the client they should not experience any discomfort.
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