PN HESI Fundamentals Exam Version 3 | Verified Q&A with Elaborations | Latest 2026–2027 | Complete Actual Exam |100% Correct rationales

PN HESI Fundamentals Exam Version 3 | Verified Q&A with Elaborations | Latest 2026–2027 | Complete Actual Exam |100% Correct rationales Q: What intervention should the practical nurse (PN) implement to meet the physiologic integrity of a client during a manic episode of bipolar disorder? A. Provide the client with finger foods. B. Restrict the client's oral fluid intake. C. Give the client low-protein, low-calorie snacks. D. Interrupt the client's performance of rituals. A. Provide the client with finger foods. During the manic phase of bipolar disorder, a client is often unable to sit still long enough to eat, so the client should be provided finger foods that can be eaten while hyperactive. Q: A client with bipolar disorder is being treated with cognitive therapy. Which actions should the practical nurse (PN) implement to reenforce this treatment strategy? Select all that apply. A. Recommend daily physical activity. B. Use affirmations and limit setting. C. Allow the client to talk continuously. D. Report client's suicidal expressions to the therapist. E. Encourage substituting positive thoughts for negative thoughts. F. Reenforce relaxation techniques when experiencing negative thoughts. B. Use affirmations and limit setting. D. Report client's suicidal expressions to the therapist. E. Encourage substituting positive thoughts for negative thoughts. Clients diagnosed with bipolar disorder may experience depressive thoughts and/or attempt suicide. Cognitive therapy sometimes produces relief from troubling symptoms experienced by clients with bipolar disorder. Cognitive therapy allows clients to handle "thought errors" and behaviors to stop negative thoughts. Q: The practical nurse (PN) is evaluating a client's self management of type 1 diabetes mellitus (DM). Which findings provide the best parameter in the client's goals for the prevention of long term complications of DM? A. Strict adherence to a diabetic diet. B. Participation in a regular exercise program. C. Scheduled administration of accurate insulin doses. D. Consistent hemoglobin A1c levels no greater than 7%. D. Consistent hemoglobin A1c levels no greater than 7%. For optimal diabetic control, evidence-based guidelines recommend an A1c target level no greater than 7% for a client with DM, which is the primary goal and indicator of effective treatment and diabetes management. Q: Which action should the practical nurse (PN) implement for a young girl with pulmonary infection who is receiving chest physiotherapy? A. Encourage to hold her breath and then cough. B. Administer bronchodilators after the procedure. C. Allow the child to sit in a position of choice. D. Percuss the chest wall in a rhythmic fashion. D. Percuss the chest wall in a rhythmic fashion. Thick secretions that are difficult to cough up can be loosened by tapping, or percussing, and vibrating the chest. Percussion is carried out by cupping the hands and lightly striking the chest wall in a rhythmic fashion over the lung segment to be drained Q: The practical nurse (PN) is preparing to administer erythromycin (Ilotycin) 0.5% ophthalmic ointment to a newborn. The father asks the PN the purpose of this medication. What rationale should the PN provide? A. To allow the baby's eyes to focus. B. To lubricate the baby's eyes. C. To prevent infection in the baby's eyes. D. Refer the father to the pediatrician. C. To prevent infection in the baby's eyes. Erythromycin is prescribed in the prophylaxis of ophthalmia neonatorum caused by Neisseria gonorrhea and Chlamydia trachomatis. The PN should explain the ointment is a prophylactic treatment to prevent infection in the baby's eyes. Q: A client's cardiac telemetry reveals sinus bradycardia at 40 beats/minute. An IV dose of atropine is given per protocol. Which finding should the practical nurse (PN) identify as a therapeutic response? A. A decrease in blood pressure. B. A decrease in premature contractions. C. An increase in heart rate. D. An increase in sensorium. C. An increase in heart rate. Atropine increases heart rate (C) by its anticholinergic effects on the sinoatrial (SA) node. Q: A client is admitted with a tumor of the hypothalamus. Which finding should the practical nurse (PN) report to the charge nurse? A. A pulse rate of 98 beats/min. B. Respirations of 20 breaths/min. C. An oral temperature of 101.8° F. D. A blood pressure of 130/80 mm Hg. C. An oral temperature of 101.8° F. The hypothalamus controls body temperature, so variation in the temperature should be reported to determine if the elevation is related to infection or cerebral pathology. Q: The practical nurse (PN) is reinforcing instructions to a client who is scheduled for a bone marrow aspiration. The PN should prepare the client for the procedure at which site? A. The femur. B. The scapula. C. The antecubital fossa. D. The posterior iliac crest. D. The posterior iliac crest. Bone marrow samples are commonly aspirated from the posterior iliac crest or sternum, which are readily accessible obtaining a specimen of bone marrow via the biopsy needle. Q: Which discharge instructions should the practical nurse (PN) reinforce with a client who has acute cholecystitis? A. Limit oral intake to three regular meals per day. B. Drink fluids between meals rather than with meals. C. Consume a low-fat diet in smaller, more frequent meals. D. Limit dietary fat intake to 35% of the daily calorie intake. C. Consume a low-fat diet in smaller, more frequent meals. Clients with acute cholecystitis are placed on small, frequent low-fat meals to decrease contraction of the gallbladder, thus decreasing pain, nausea, and vomiting. Q: A male client draws back when the practical nurse (PN) reaches over the side rails to take his blood pressure. To promote effective communication, what should the PN do? A. Continue to perform the procedure quickly and quietly. B. Apologize for startling the client and explain the need for contact. C. Tell the client that the blood pressure can be taken at a later time. D. Rotate the nurses who are assigned to take the client's blood pressure. B. Apologize for startling the client and explain the need for contact. Nurses often have to enter a client's personal space to provide care, which requires respect for the client's privacy. Apologizing and explaining the need for contact demonstrates respect and provides information so the client may understand the need for personal contact. Q: A client with delirium is confused and disoriented to time and place. He states he is experiencing visual illusions and tactile hallucinations. What actions in the plan of care should the practical nurse (PN) implement? Select all that apply. A. Interact in an energetic manner to dismiss misperceptions. B. Provide a wide variety of environmental stimuli. C. Give simple explanations about nursing care to be given. D. Remove unnecessary furniture and equipment from the room. E. Encourage self care to promote client independence. F. Identify oneself each time the client is approached. C. Give simple explanations about nursing care to be given. D. Remove unnecessary furniture and equipment from the room. F. Identify oneself each time the client is approached. Explanations should be simple, concrete, and concise to ensure the client's understanding and cooperation. Simplifying the environment reduces the potential for sensory-perceptual misinterpretations. The PN should introduce him- or herself with each client contact when providing nursing care. Q: Following a client's bladder surgery, the practical nurse (PN) notes that the ureteral catheter is no longer draining urine. What action should the PN implement? A. Notify the healthcare provider immediately. B. Change the client's position and continue to monitor. C. Clamp the ureteral catheter for 30 minutes. D. Irrigate the ureteral catheter with 30 ml of sterile saline. A. Notify the healthcare provider immediately. When ureteral stents or catheters are placed, patency must be maintained to prevent hydronephrosis. Any significant decrease in drainage should be reported immediately. Q: A male client is being discharged after starting a new prescription of olanzapine (Zyprexa) for paranoid schizophrenia. Which discharge instructions should the practical nurse (PN) reinforce with the client? A. Sit in the sunlight for 20 minutes everyday. B. Avoid the use of antihistamines and alcohol. C. Maintain an average dietary intake of sodium. D. Defer making business decisions for a month. B. Avoid the use of antihistamines and alcohol. Zypexia, an atypical antipsychotic that improves negative symptoms, can produce sedating effects early in therapy, so concomitant use of alcohol or antihistamines should be avoided to minimize synergistic effects. Q: In which position should the practical nurse (PN) place a client after the client has a liver biopsy? A. Prone. B. Supine. C. Left side-lying. D. Right-side lying. D. Right-side lying. The largest lobe of the liver, which is the most frequently biopsied site, lies in the right hypochrondriac region of the abdomen. After a liver biopsy, the client should be turned onto the right side for the first 2 hours to provide local pressure to the puncture site to minimize bleeding. Q: The practical nurse is discussing glucose balance with a client who is newly diagnosed with type 2 diabetes mellitus. Which physiological process supports the movement of glucose into the cells? A. Glucose moves to low concentrations in the cell. B. Blood pressure pushes glucose into cells. C. Insulin is needed to carry glucose into cells. D. Cells absorb glucose when needed. C. Insulin is needed to carry glucose into cells. The transport of glucose occurs because insulin carries glucose across the cell membrane. Q: A mother who is a single parent of three children comes into the well-child clinic and tells the nurse that she needs to start prenatal visits because she unexpectantly is pregnant. To determine how well the client is coping with the pregnancy, which information should the practical nurse obtain? A. The type of work the client is currently doing for employment. B. The client's plans for marriage in the near future. C. The client's support person during this pregnancy. D. The client's use of any type of contraception. C. The client's support person during this pregnancy. An unexpected pregnancy can be a situational crisis for a single-parent family. Personal or family support systems and coping mechanisms should be identified with this mother. Q: Which action should the practical nurse (PN) implement to improve delivery of care by an unlicensed assistive personnel (UAP) who is providing less than optimal hygienic care to older adult clients? A. Give the UAP verbal instructions on how to correctly give baths. B. Ask another staff member to provide special skin care in the afternoon. C. Demonstrate to the UAP how to give a gentle bath to a client. D. Provide the UAP with reading and resources on bathing older clients. C. Demonstrate to the UAP how to give a gentle bath to a client. The PN should demonstrate to the UAP how to provide a gentle bath, which also allows the PN to role model how to convey a sense of caring and respect for the client during the procedure. Q: The practical nurse (PN) explains details of drawing up a dosage of insulin and uses an insulin syringe and vial to show a client how to manipulate the equipment while withdrawing the solution. To evaluate the client's understanding, what action should the PN implement next? A. Review the steps of the procedure with the client the next day. B. Give the client written materials to study and learn the procedure. C. Ask the client to explain the procedure after the demonstration. D. Direct client to use the syringe to withdraw a dose of insulin from the vial. D. Direct client to use the syringe to withdraw a dose of insulin from the vial. Hands-on practice reenforces learning and evaluates the client's understanding about handling equipment after watching a detailed step-by-step demonstration. Q: A male client who had an emergency bowel resection for a ruptured diverticulum 36 hours ago is displaying increased restlessness, and his pulse rate is 110 beats/minute. He is exhibiting gross hand tremors and is plucking at the sheets and gown. During the next 48 hours, it is most important for the practical nurse (PN) to implement what nursing action? A. Provide a safe environment. B. Promote honest client self-appraisal. C. Educate the client about substance abuse. D. Make the client aware of treatment options. A. Provide a safe environment. The client is experiencing symptoms consistent with early alcohol withdrawal syndrome, so should be a priority nursing action. During alcohol withdrawal the client can become agitated and experience sensory-perceptual distortions, which increases his risk for injury associated with pulling out intravenous (IV) lines and tubes and with falling. Q: A female visitor walks up to the practical nurse (PN) in the hall and asks if the male client who she is visiting is going to recover from his illness. Which response should the PN provide? A. Explain that client information cannot be shared. B. Check the chart for the client's health history and information. C. Direct the visitor to talk with the charge nurse. D. Tell the visitor to inquire with the client about his status. A. Explain that client information cannot be shared. Maintaining client confidentiality in clinical practice is best supported by stating that client information cannot be shared with others without the client's specified permission. A client with T6 spinal cord injury who is implementing intermittent catheterization for bladder training suddenly complains of a throbbing headache. The practical nurse (PN) determines the client's blood pressure is elevated. What additional assessment should the PN implement? A. Evaluate urine volumes obtained during bladder training. B. Palpate the client's bladder for distention. C. Calculate the PO fluid intake for the day. D. Determine if a PRN antihypertensive is prescribed. B. Palpate the client's bladder for distention. Autonomic dysreflexia, a potentially life-threatening complication, is manifested by elevated blood pressure in a client with a thoracic spinal cord injury. The most frequent cause is bladder distention, so palpation of the bladder for distention should be implemented to plan interventions to relieve the triggering stimuli. The practical nurse (PN) is caring for a female client with a T2 spinal cord injury who is scheduled to begin intensive rehabilitation. When the PN is assisting the client to transfer to a wheelchair, the client tells the PN that she does not feel like getting up. The client complains of a sudden onset of a severe throbbing headache. Which action should the PN implement first? A. Report the findings to the charge nurse. B. Check the client's blood pressure. C. Check the client for an impaction. D. Encourage the client to sit upright in the wheelchair. B. Check the client's blood pressure. In spinal cord injuries above T6, autonomic dysreflexia, manifested by a sudden onset of an acute headache, results in an elevated blood pressure in response to a noxious physical stimuli. Checking the blood pressure is the first assessment. The practical nurse (PN) administers a prescribed opiate for a client with acute pancreatitis who is having severe abdominal pain. Which additional intervention in the plan of care should the PN implement? A. Monitor daily serum amylase levels. B. Maintain client's NPO status. C. Give prescribed morphine PRN. D. Place client in a position of comfort. B. Maintain client's NPO status. A client with acute pancreatitis should be NPO to minimize pancreatic auto-digestion from pancreatic enzymes. The practical nurse (PN) is assessing a client who was transferred to the postoperative care unit 1 hour ago. What action should the PN implement to evaluate the client for ineffective airway clearance? A. Observe the client's independent use of incentive spirometer. B. Take vital signs, including body temperature, every 4 hours. C. Auscultate breath sounds before and after respiratory exercises. D. Measure oxygen saturation (SpO2) after respiratory interventions. C. Auscultate breath sounds before and after respiratory exercises. Ineffective airway clearance is best revealed by an inability to clear tenacious secretions. Auscultating breath sounds before and after respiratory exercises indicates if deep breathing affects abnormal breath sounds, shallow respirations, and nonproductive cough. A male client who is newly diagnosed with an ulcer is prescribed an antibiotic. He asks the practical nurse (PN) why this treatment is necessary for an ulcer. What information should the PN provide? A. Additional treatment is indicated if he continues a spicy diet. B. Decreased gastrin production is promoted with antibiotic therapy. C. Antibiotics increase bicarbonate retention to buffer hyperacidity. D. Helicobacter pylori infection is a common cause of gastric ulcers. D. Helicobacter pylori infection is a common cause of gastric ulcers. Helicobacter pylori infection promotes gastric ulcers by enzymatic degradation of the protective mucous layer, so antibiotic treatment is necessary to eradicate the organism and its cytotoxic action on gastric mucosal cells A male client who is newly diagnosed with an ulcer is prescribed an antibiotic. He asks the practical nurse (PN) why this treatment is necessary for an ulcer. What information should the PN provide? A. Additional treatment is indicated if he continues a spicy diet. B. Decreased gastrin production is promoted with antibiotic therapy. C. Antibiotics increase bicarbonate retention to buffer hyperacidity. D. Helicobacter pylori infection is a common cause of gastric ulcers. D. Helicobacter pylori infection is a common cause of gastric ulcers. Helicobacter pylori infection promotes gastric ulcers by enzymatic degradation of the protective mucous layer, so antibiotic treatment is necessary to eradicate the organism and its cytotoxic action on gastric mucosal cells. The practical nurse (PN) deflates a male client's tracheostomy tube cuff to evaluate his ability to swallow. What action should the PN implement? A. Deflate the cuff during the client's inhalation. B. Clean the inner cannula of the tracheostomy tube. C, Suction the trachea and then the mouth before deflating the cuff. D. Measure the amount of air removed from the cuff during deflation C. Suction the trachea and then the mouth before deflating the cuff. The mouth and trachea should be suctioned before and after deflation of the tracheostomy tube's cuff to minimize aspiration. The practical nurse (PN) gently touches the shoulder of a client who is weeping and who does not want to be in the hospital. What is the purpose of the PN's use of therapeutic touch? A. Conveys the practical nurse's caring and support when words are difficult. B. Acts as a positive intervention in all nurse-client interactions. C. Should be avoided because of possible cultural misinterpretation. D. Best for young children and older clients with difficulty expressing self. A. Conveys the practical nurse's caring and support when words are difficult. Nonprocedural or therapeutic touch is an effective technique in the nurse-client relationship that conveys support and communicates caring to the client. The practical nurse (PN) is reviewing preoperative instructions with a preschooler. Which technique should the PN use to most effectively promote the child's understanding? A. Focus on examples of how other children have done. B. Allow the child to manipulate some of the equipment to be used. C. Use cartoon analogies to explain health-related ideas. Incorrect D. Explain the sequence of events quickly to avoid distracting the child. B. Allow the child to manipulate some of the equipment to be used. Toddlers and preschoolers should be allowed to touch and examine objects that they will come in contact with during the preoperative period. A female client is being prepared for pelvic ultrasonography. What information should the practical nurse (PN) give this client in preparation for the diagnostic test? A. Eat or drink nothing after midnight. B. Empty bladder fully before arriving. C. Take enemas at home until the stool is clear of color. D. Drink a liter of water 1 hour before the procedure. D. Drink a liter of water 1 hour before the procedure. Ultrasound uses reflected sound waves to produce pictures of intra-abdominal organs, pelvis, bladder, and prostate, as specified by the prescription. For pelvic ultrasonography, the client should drink a liter of water before the procedure, which ensures the the echo-reflection patterns of the sonogram can distinguish the bladder from the reproductive organs that lie nearby. Which information to improve nutritional status should the practical nurse (PN) offer an older female client who lives alone? Select all that apply. A. Decrease intake of fluids to improve appetite. B. Use herbs to spice up the flavor of foods instead of extra salt. C. Keep the environment stress-free to concentrate on eating. D. Cook favorite foods in bulk and freeze in individual serving containers. E. Use disposable dishes to reduce the need for after meal clean-up. B. Use herbs to spice up the flavor of foods instead of extra salt. D. Cook favorite foods in bulk and freeze in individual serving containers. The use of herbs instead of extra salt minimizes the risk of fluid retention and elevated blood pressure that is common in the elderly. Cooking and freezing favorite foods for easy preparation later is helpful in improving the overall nutrition of an older client. A client admitted with major depression is placed on suicide precautions. While orienting the client to the unit, what activity should the practical nurse (PN) implement? A. Assign the same unlicensed assistive personnel for one on one observations. B. Explain the purpose and implementation of suicide precautions. C. Discuss that visitors will be limited during the client's close observation period. D. Obtain the client's permission to search his personal items. B. Explain the purpose and implementation of suicide precautions. A client on suicide precautions should be informed about the purpose and parameters of suicidal precautions, which include use of selected personal items under direct supervision, removal of sharp objects, observation at frequent intervals, and restriction to the unit. The practical nurse (PN) observes an unlicensed assistive personnel (UAP) accidentally drop a vial of blood while placing it in a biohazard bag for transport to the laboratory. How should the PN direct the UAP to clean up the blood spill on the floor? A. Wipe the spill with disposable cloths and discard the cloths in the trash receptacle lined with plastic. B. Call housekeeping team to clean up the blood spill and decontaminate the area. C. Absorb blood with a mop head and dispose in a biohazard bag for incineration. D. Use paper towels to absorb blood for disposal in biohazard container and treat floor with disinfectant. D. Use paper towels to absorb blood for disposal in biohazard container and treat floor with disinfectant. Blood is a biohazard that requires disposal and standard precautions in cleaning environmental contamination of potentially blood borne transmission. The UAP should be instructed to wear gloves while absorbing the blood and disposing the pads in a biohazard bag and while cleaning the area on the floor with a disinfectant. The healthcare provider prescribes wrist restraints for an older male resident in a long term care facility who is confused and has pulled out his urinary catheter twice. The practical nurse (PN) assesses the client's radial pulses and skin condition under the restraint every 2 hours. Which additional measures should the PN implement? Select all that apply. A. Verify that restraints are prescribed on an as-needed basis. B. Remove the restraints daily to reevaluate the client's needs. C. Ask the client for his consent to be restrained for his safety. D. Discontinue the restraints when the client is no longer at risk for self injury. E. When the time frame of the prescription has lapsed, discontinue the restraints. B. Remove the restraints daily to reevaluate the client's needs. D. Discontinue the restraints when the client is no longer at risk for self injury. Restraints should be periodically removed to determine if they should be continued or discontinued. The practical nurse (PN) palpates the insertion site of an IV infusion that is pale and swollen, and determines the area is cool to touch. Which action should the PN implement first? A. Report to the nurse. B. Apply warm compresses to the site. C. Monitor client's temperature q4 hours. D. Discontinue the IV infusion. D. Discontinue the IV infusion. Infiltration is the most common complication of intravenous (IV) therapy and is evident by pale, swollen, and cool tissue at the site. The first action is to discontinue the infusion to minimize the volume of fluid extravasation. The practical nurse (PN) is administering an otic medication to an adult client. In which direction should the PN pull the pinna during instillation? A. Up and back. B. Down and back. C. Up and forward. D. Down and forward. A. Up and back. The pinna of the adult should be pulled up and back, to ensure the medication flows through the external ear canal and to the tympanic membrane. What method should the practical nurse (PN) implement to elicit information from a client during an admission interview? A. Explain the purpose of the admission interview. B. Summarize with the client the information collected. C. Ask information-seeking or closed-ended questions. D. Request relatives to leave during the interview. C. Ask information-seeking or closed-ended questions. Closed questions have a definite place when specific essential data, such as information seeking, is needed during the initial phases of data collection. An older client who is a resident in a skilled nursing facility likes to walk for exercise. The client is taking a vasodilator for hypertension. Which action should the practical nurse (PN) implement for this client? A. Monitor blood pressure daily. B. Provide a walker for long walks. C. Document intake and output. D. Assist client to stand up slowly. D. Assist client to stand up slowly. Blood pressure fluctuations with position changes are common in the elderly and increase the risk of falls when taking medications that can cause orthostatic hypotension. To minimize falls related to dizziness with mobilization, the PN should assist the client to stand up slowly (D) before beginning to ambulate. Which finding requires immediate action by the practical nurse (PN)? A. The client's affected heel is supported off of the bed. B. The weights are touching the floor at the end of the bed. C. The affected leg and foot are resting away from the footboard. D. The client's affected leg is aligned parallel to the edge of the bed. B. The weights are touching the floor at the end of the bed. To ensure the weight of the Buck's traction is creating a pull to reduce a fracture and relieve muscle spasms, the PN should intervene when the weights are on the floor and not hanging freely. To help prevent complications for a client who is abusing amphetamines, it is important for the practical nurse to implement what action? A. Measure intake and output. B. Perform neurologic assessments. C. Check oxygen levels frequently. D. Keep the lights on continuously. B. Perform neurologic assessments. Amphetamines are CNS stimulants that increasing cardiovascular centers. Close monitoring of a client who is abusing amphetamines should focus on changes in cardiac or neurologic status since myocardial infarction and cerebral hemorrhage have occurred from amphetamine abuse. A male client who was hospitalized for depression 1 month ago is being discharged. The client asks a female practical nurse (PN) for a date when he gets home. How should the PN respond? A. Decline and state that another person is significant to the PN. B. Explain hospital policy that does not allow nurses to date clients. C. Accept the invitation but clarify that their meeting should be platonic relationship. D. Explain the nurse-client relationship is a professional relationship, not a social one. D. Explain the nurse-client relationship is a professional relationship, not a social one. Clients often view their nurses in a positive fashion and are often reluctant to terminate the nurse-client relationship and seek to continue social contact after discharge. Helping the client clarify the professional role of the PN provides the most therapeutic response. In addition to lowering dietary sodium intake, which dietary changes should the practical nurse (PN) encourage the client to make when learning to manage high blood pressure? A. Vary the types of dairy products, such and milk and cheese. B. Select vegetable proteins, such as canned beans. C. Include calcium and magnesium food sources daily. D. Increase protein source of shellfish to most days of the week. C. Include calcium and magnesium food sources daily. Diet and exercise can reduce high risk behaviors and promote healthy living life styles. Adequate levels of calcium and magnesium play a role in the maintenance of blood pressure. A client is admitted with possible head trauma after a motor vehicle collision. Which action should the practical nurse (PN) implement? A. Auscultate heart sounds. B. Monitor client's weight. C. Check for verbal and motor response. D. Auscultate lung and abdominal sounds. C. Check for verbal and motor response. A client experiencing a traumatic closed head injury should be monitored for signs of increased intracranial pressure (ICP). A neurologic examination, such as the Glasgow Coma Scale, is performed the detect early signs of ICP, as manifested by changes in verbal and motor response. A client who is taking gentamicin (Garamycin) tells the practical nurse (PN) that he has been hearing ringing in his ears since he began his prescription. What additional assessment finding should the PN report to the healthcare provider? A. Thirst. B. Diarrhea. C. Sedation. D. Dizziness. D. Dizziness. Gentamicin, an aminoglycoside antibiotic, is known to have ototoxic side effects, which are manifested by tinnitus and vertigo. Complaints of ringing in the ears accompanied by dizziness are early signs of hearing loss and should be reported to the healthcare provider. The practical nurse (PN) is caring for a client in the oliguric phase of acute renal failure (ARF). What nursing action should the PN implement? A. Meticulous skin care. B. Liberal fluid intake. C. Protective isolation precautions. D. High dietary protein intake. A. Meticulous skin care. Poor nutritional status and edema accompanying renal failure can cause skin breakdown. Meticulous skin care, frequent turning, and special mattresses are priority concepts in basic care and comfort. An older Hispanic woman is admitted to the skilled nursing facility for rehabilitation following a hip replacement. She is alert, oriented, and cooperative but speaks only Spanish. Her adult children interpret for her when they are present. What management plan to communicate with this client should the practical nurse (PN) implement? A. Have the children arrange to have one of them present at all times. B. Communicate with the client only when the children are present and can translate. C. Use a translation guide with commonly used pictures and phrases. D. Obtain an interpreter to help the client learn English during rehabilitation. C. Use a translation guide with commonly used pictures and phrases. A simple translation guide using pictures and phrases can be used with a cooperative client in this non nonacute setting. The practical nurse (PN) is caring for a client with pernicious anemia. What role does gastrin play in this disease? A. Enzyme that assists protein digestion. B. Hormone that stimulates the appetite. C. Enzyme that converts glucose to glycogen. D. Hormone that stimulates release of gastric juices. D. Hormone that stimulates release of gastric juices. Pernicious anemia results from inability to absorb vitamin B12 which requires gastric hydrochloric acid for the absorption of B12 from the intestines into the blood stream. Gastrin, a hormone secreted by the gastric mucosa near the pyloric area and duodenum, stimulates the release of hydrochloric acid in the stomach. A client's blood pressure is being monitored with an arterial catheter placed in the brachial artery. To prevent neurovascular complications while the catheter is in place, what action should the practical nurse (PN) implement? A. Perform an Allen test to validate circulation to the hand. B. Assess continuous-flush irrigation system q1 to 4 hours. C. Ensure that all tubing connections are secure. D. Check pulses distal to the insertion site hourly. D. Check pulses distal to the insertion site hourly. Arterial lines carry the risk of hemorrhage, infections, thrombus formation, and neurovascular impairment. Pulse and circulation distal to the arterial insertion site should be assessed hourly to monitor for neurovascular impairment that can cause irreversible tissue damage. A male client returns to the surgical nursing unit from the postanesthesia care unit and is still drowsy. The practical nurse (PN) uses verbal stimulation to keep the client responsive. In what position should the PN place the client until he is more reactive? A. Supine. B. Side-lying. C. Head of bed at 30 degrees with head and neck midline. D. Head of bed at 45 degrees with head and neck midline. B. Side-lying. The client should be turned to a side-lying position or positioned with his head turned to the side to prevent aspiration. Which information should the practical nurse (PN) reenforce for a client who has signed an informed consent for a surgery? Select all that apply. A. The expected benefits and outcomes of the procedure. B. Exclusion of risks of not having the procedure. C. Explanation about ineffectiveness of alternative therapies. D. The nature of the therapy or procedure. E. Potential risks of the procedure. A. The expected benefits and outcomes of the procedure. D. The nature of the therapy or procedure. E. Potential risks of the procedure. Informed consent is mandated by federal statute and state law and requires the healthcare provider to disclose the nature of the therapy or procedure, the expected benefits and outcomes of the procedure, the potential risks of the procedure, alternative therapies to the intended procedure including their risks and benefits, and risks of not having the procedure. To obtain a client's apical heart rate, which anatomical location should the practical nurse (PN) use when auscultating at the point of maximal impulse (PMI)? A. Fifth intercostal space, left midclavicular line. B. Second intercostal space, right midclavicular line. C. Fifth intercostal space, left anterior axillary line. D. Fourth intercostal space, left lateral sternal border. A. Fifth intercostal space, left midclavicular line. The PMI of the heart is located at the fifth intercostal space, along the left midclavicular line. A male client with a history of a recent stroke has right-sided paralysis, which is his dominant side, and he is unable to speak. Which action in providing hygiene should the practical nurse (PN) implement to encourage the client's rehabilitation? A. Give the client a full bed bath and back massage and provide mouth care. B. Tell the client to wash whatever is possible by himself to provide privacy. C. Ask a family member to give a full bath to evaluate ability to care for the client at home. D. Offer assistance while encouraging client to use left hand to wash face and brush teeth. When learning to use his nondominant hand, the client should be encouraged to do as much of his or her hygiene as possible to progress to independence. A client with type 1 diabetes mellitus who uses an insulin pump comes to the clinic for follow-up evaluation. The client consistently has a fasting blood glucose between 70 and 80 mg/dl, a postprandial blood glucose level below 200 mg/dl, and a hemoglobin A1c level of 5.5%. What evaluation should the practical nurse (PN) convey to the client? A. Signs of insulin resistance. B. Good control of blood glucose. C. Risk for developing hypoglycemia. D. Increased risk for hyperglycemia. B. Good control of blood glucose. Based on standardized guidelines, the client is maintaining blood glucose levels within the defined ranges for tight control (fasting blood glucose 60 to 120 mg/dl, postprandial blood glucose less than 200 mg/dl, hemoglobin A1c no greater than 7%) The practical nurse (PN) is caring for a client with a chest tube and finds there is an absence of bubbling in the suction control chamber of the chest tube. What action should the PN implement first? A. Turn up the wall suction. B. Report the finding to the charge nurse. C. Check the tubing for air leaks. D. Add water to the suction control chamber. C. Check the tubing for air leaks. Bubbling is expected in the suction control chamber of chest tubes when suction is applied. Absence of bubbling may indicate a leak in the tubing, so the PN should first check all tubing connections for a potential source of air leaks. Twelve hours after implantation of a cervical cesium implant, the practical nurse (PN) finds the client crying. What action should the PN provide? A. Leave the client alone to cry in private. B. Don a lead shield and sit at her bedside. C. Call the client on the phone and ask her why she is crying. D. Stand at the head of the bed and offer support for 15 minutes. D. Stand at the head of the bed and offer support for 15 minutes. The cesium implant delivers radiation at the tumor site and places healthcare workers at risk for radiation exposure. Emotional support should be provided with bedside presence while limiting radiation exposure by standing at the head of the bed, several feet away from the implants, and by limiting the duration of the client visit. A new mother who delivered vaginally is being discharged today with her first-born infant. Which information is most important for the practical nurse (PN) to review with the client before she goes home with the new infant? Select all that apply. A. Breast feeding techniques and bottle supplementation. B. Self care of the episiotomy. C. Signs or symptoms of infection. D. Weaning from breast-feeding to bottle feeding. E. Infant immunizations during the first year. A. Breast feeding techniques and bottle supplementation. B. Self care of the episiotomy. C. Signs or symptoms of infection. Self care and infant care are priority discharge topics that should be reviewed with the client before the client goes home with the baby. Which information is most important for the practical nurse (PN) to obtain when preparing a client for an electroconvulsive treatment (ECT) on an "outpatient" basis? A. Has the client maintained NPO status for 8 hours before the ECT? B. Does the client understand the ECT treatment and side effects? C. Did the client take any cardiac, antihypertensive, or H2 medications? D. Are all client prostheses removed before the ECT treatment? A. Has the client maintained NPO status for 8 hours before the ECT? Clients who receive ECT on an outpatient basis are asked to stay NPO for 8 hours before treatment to prevent aspiration from general anesthesia. Which action is most important for the practical nurse (PN) to implement when applying a wet dressing to the skin of a client with impetigo? A. Use antimicrobial soaps and cool solutions to cleanse lesions. B. Wear clean gloves when in contact with wound drainage. C. Apply topical antibiotic ointment to wound at dressing changes. D. Pour saline on 4-inch square gauze for direct application B. Wear clean gloves when in contact with wound drainage. Impetigo, caused by group A b-hemolytic Streptococci or Staphylococci, is infectious and contagious. Drainage from the lesions requires the implementation of standard precautions to prevent spread of the infection. The practical nurse (PN) is interviewing a client who has intermittent chest pain while working in the garden. Which history should the PN obtain that predisposes this client to cardiovascular disease? Select all that apply. A. Obesity. B. Diabetes. C. Hypertension. D. Hyperlipidemia. E. Family history. F. Type B personality. A. Obesity. B. Diabetes. C. Hypertension. D. Hyperlipidemia. E. Family history. Risk factors that are related to inheritance that may lead to cardiovascular disease include obesity, diabetes, hypertension, high cholesterol, and family history. The practical nurse (PN) is performing a digital extraction of an impaction for an older client. Which finding indicates to the PN that the procedure should be stopped? A. Slowing heart rate below 60 beats/minute. B. Reflex incontinence of urine and stool. C. Increased blood pressure by 20 mmHg D. Increased respiratory rate by 6 breaths. A. Slowing heart rate below 60 beats/minute. The stimulation of the rectum by digital examination may stimulate the vagus nerve, which then slows the heart rate, so the client should be monitored for reflex bradycardia. The practical nurse (PN) is reinforcing teaching provided to a male client about self administration of subcutaneous insulin. What action should the PN use to best evaluate the client's learning? A. Give a written test on diabetic precautions and complications. B. Provide the client with reading materials and pictorial handouts. C. Ask the client if he understands all the steps of subcutaneous administration. D. Use a combination of the client's explanations and demonstration of self injection. D. Use a combination of the client's explanations and demonstration of self injection. To best evaluate learning, the PN should observe the client demonstrating the injection procedure while explaining each step, its rationale, and precautions. A client who is 3 days postoperatively for a coronary artery bypass graft surgery (CABG) has a serum potassium level of 4.5 mEq/L. What action should the practical nurse (PN) implement based on this finding? A. Notify the healthcare provider. B. Document the finding only. C. Administer potassium replacement. D. Decrease the IV solution flow rate. B. Document the finding only. Post CABG can contribute to hypokalemia from hemodilution, nasogastric suction, or diuretic therapy, so monitoring serum electrolytes is important to determine the client's risk for cardiac dysrhythmias. The client's serum potassium is within normal limits (norm 3.5 to 5.0 mEq/L) and requires documentation only. What action should the practical nurse (PN) implement to improve the quality of sleep for a confused client? A. Give warm black tea at bedtime. B. Keep client awake during the day. C. Give routine sedative medications at HS. D. Avoid HS care 90 minutes before bedtime B. Keep client awake during the day. Stimulating the client to be active and awake during the day allows the client to experience some fatigue by nighttime so sleep is easier to achieve. A 17-year-old male comes to the clinic for his pre-college physical examination. During the interview, he tells the practical nurse (PN) that although he has been actively engaged in sports, music, and academics, he still does not know what he would like to do after graduation. How should the PN respond? A. Encourage him to speak with his parents about his confusion about his future. B. Recommend that he choose one area on which to focus so that he begins to develop a firmer sense of identity. C. Acknowledge the difficulty of this decision-making while supporting his desire to continue to explore his options. D. Suggest that he explore different part-time work options while going to college. C. Acknowledge the difficulty of this decision-making while supporting his desire to continue to explore his options. Erikson's stage of adolescent sense of identity is a development milestone that often continues into early young adulthood when career options in college are explored. Acknowledging the teen's difficulty in deciding about his future offers support that his search is a normal stage. A client who is recently diagnosed with bipolar disorder receives a new prescription for lithium (Eskalith). Which information should the practical nurse (PN) reenforce to ensure the client's understanding? A. Obtain serum lithium blood levels once a month. B. Eliminate foods high in salt from the daily diet. C. Discontinue lithium if fine hand tremors occur. D. Withhold lithium if fever develops during a "cold." A. Obtain serum lithium blood levels once a month. Monthly serum lithium should be monitored to ensure the prescribed dosage maintains the client's blood levels within a narrow therapeutic range. A client who delivered a normal baby 4 hours ago has been unable to void. What nursing intervention should the practical nurse (PN) implement first? A. Increase oral fluid intake to 2500 ml. B. Use urinary catheter to drain bladder. C. Rinse the perineum with warm water. D. Palpate suprapubic area for distention. C. Rinse the perineum with warm water. Non-invasive measures, such as pouring warm water over the client's perineum to create the urge to urinate should be implement first. The practical nurse (PN) is examining a newborn and identifies that the gluteal skin folds of the buttocks are uneven and one of the thighs is shorter than the other. Which assessment should the PN implement next? A. Visualize the anal and urinary meatus openings. B. Manipulate both ankles for range of motion. C. Count the number of fingers and toes. D. Flex and abduct hips simultaneously D. Flex and abduct hips simultaneously A focused assessment for congenital hip dysplasia, which is manifested with uneven gluteal skin folds, apparent shortening of one femur, and limited abduction with flexion of hips during the Ortolani maneuver, should be performed. The practical nurse (PN) assigns the unlicensed assistive personnel (UAP) to take the vital signs for a client with bacterial meningitis. Which finding should the PN direct the UAP to report immediately? A. Subnormal temperatures. B. Muscle flaccidity. C. Low blood pressure. D. Changes in consciousness. D. Changes in consciousness. In bacterial meningitis, meningeal irritation can cause complications such as seizures and increased intracranial pressure (ICP). The UAP should be directed to report a change in the client's consciousness, which is an early sign of elevated ICP that can compromise cerebral perfusion. Which client outcome should the practical nurse (PN) identify for a client with heart failure (HF)? A. The client's weight fluctuates by less than 2 kg per day. B. The client requests medication for anxiety only at night. C. The heart rate increases by 50 beats per minute with mild exercise. D. The client is able to dress and feed self without experiencing dyspnea. D. The client is able to dress and feed self without experiencing dyspnea. A client with HF that is effectively managed should be independent with activities of daily living without dyspnea. A client visits the clinic with complaints of sleep loss and wants a prescription for sleeping pills. The practical nurse (PN) learns that the client is also drinking tea at the evening meals. What action should the PN implement? A. Talk to the client about history of changes in sleeping habits. B. Determine if the tea is caffeinated or has an herbal supplement in it. C. Instruct the client on the appropriate dose for the sleeping pills. D. Have a translator interpret all instructions about the sleeping pills. B. Determine if the tea is caffeinated or has an herbal supplement in it. Determining if the tea is caffeinated is the first action. A 9-year-old boy who had an emergency appendectomy during the night awakens and starts to cry when he does not see his parents at the bedside. He has an IV and a dressing covering the operative site. What action should the practical nurse (PN) implement? A. Encourage the child to calm down because big boys do not cry. B. Locate his mother and ask her to stay at the bedside with her son. C. Ask the child to recall the surgical event and assess his pain level. D. Call the healthcare provider for a prescription for a different analgesic. C. Ask the child to recall the surgical event and assess his pain level. A 9-year-old can use cognitive abilities to understand the nurse's explanation which should help him focus and assess his postoperative pain. Which acid-base imbalance is a client with a history of severe chronic obstructive pulmonary disease (COPD) likely to develop? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. C. Respiratory acidosis. The retention of carbon dioxide in a client with COPD causes chronic respiratory acidosis. A client with a massive cerebral bleed who is diagnosed as brain dead is receiving mechanical ventilation. The healthcare provider has just talked to the family about removing the client from life support. Which family concern should the practical nurse (PN) relay to the charge nurse immediately? A. Family request for an autopsy. B. Client's designation for organ donation. C. Referral to the coroner's office. D. Notification of the insurance company. B. Client's designation for organ donation. The family's concerns about the client's designation of organ donation should be reported to the charge nurse immediately so organ oxygenation can be maintained until organ procurement. A male client who is receiving hospice care receives a prescription for radiation therapy for bone metastases. The client tells the practical nurse (PN) that he is on hospice. What information should the PN provide the client? A. Eligibility for hospice care may expire if the cancer goes into remission. B. Radiation therapy provides pain relief and is a palliative care measure. C. Cost coverage for radiation therapy is only for a cancer treatment cure. D. Bone metastases cannot be halted and radiation will not affect a cure. B. Radiation therapy provides pain relief and is a palliative care measure. Palliative radiation therapy (RT) is given to relieve oncological tumor growth, pressure, and pain without affecting a cure, so its therapeutic use in providing comfort care as a hospice appropriate measure should be explained. A client has collapsed while getting out of bed, has no pulse, and is not breathing. After calling for help and an automated external defibrillator (AED), which action should the practical nurse (PN) take? A. Give two quick short breaths. B. Palpate for a carotid pulse. C. Defibrillate using the AED. D. Begin cardiac compressions. D. Begin cardiac compressions. Basic Life Support (BLS) for a client who is unconscious and not breathing should begin with cardiac compressions. The practical nurse (PN) is completing the morning focused assessment for a client who is admitted with cellulitis of the right leg. Which finding about the client's lower extremities is most important for the PN to report immediately to the charge nurse? A. Warm with bounding pulses. B. Edematous with slow capillary refill. C. Pale, cool to the touch, and diminished pulses. D. Postural color changes when feet are dependent. C. Pale, cool to the touch, and diminished pulses. An extremity that is pale, cool to the touch, and has decreased pulses is indicative of decreased perfusion that should be reported. When caring for a client receiving total parenteral nutrition (TPN), which action is most important for the practical nurse (PN) to implement? A. Review results of daily serum electrolyte analysis. B. Perform fingerstick glucose readings q6 hours. C. Monitor central venous catheter (CVC) site. D. Ensure infusion pump is functioning q8 hours. B. Perform fingerstick glucose readings q6 hours. TPN solutions contain a high concentration of glucose that can cause significant fluctuation in blood glucose levels during therapy. The PN should perform fingerstick glucose readings q6 hours to evaluate the client's tolerance to the infusion rate. Which action should the practical nurse implement when changing bed linens of a client with radioactive implant? A. Stay at the bedside under the prescribed time exposure. B. Use a N95 respirator mask with a special filter. C. Wear a paper gown and boots, gloves, and mask. D. Extend time after linen change to alleviate client's anxiety. A. Stay at the bedside under the prescribed time exposure. Radiation precautions are prescribed to protect the nurse, staff, and visitors from excessive radiation exposure. Thee 3 parameters include Time (near the source), Distance (from the source), and Shielding (lead barrier or shield between the nurse and the source). When using nonsterile procedure gloves, which action should the practical nurse (PN) implement to ensure standard precautions are provided to all clients? A. Use gloves for any contact with the client. B. Wash hands immediately after removing the gloves. C. Wash hands with gloves on before removing them. D. Use the same gloves throughout the care of the same client. B. Wash hands immediately after removing the gloves. Washing hands immediately after removing barrier gloves Decreases the likelihood that organisms may have gained access to the skin through small holes or imperfections in the gloves and reduces the transfer of microorganisms to the environment and other clients. A male client with acute pancreatitis has a nasogastric tube (NGT) to suction. He asks the practical nurse (PN) if he can have some sips of water or ice chips. Which rationale should the PN explain to the client about remaining NPO? A. To prevent nausea and vomiting. B. To minimize pancreatic secretions that cause pain. C. To remove any precipitating irritants from the stomach. D. To correct fluid and electrolyte imbalance. B. To minimize pancreatic secretions that cause pain. Maintaining NPO status and removing gastric secretions via NGT suction minimizes gastric contents that stimulate the release of pancreatic enzymes that cause auto-digestion of the pancreas and subsequent pain. A client who is ready for transport from the postanesthesia care unit (PACU) to the postoperative unit continues to complain of pain at the incision site. What action should the practical nurse (PN) implement? A. Administer a dose of analgesic as written in the client's postoperative prescriptions. B. Give a half-dose of the prescribed postoperative dosage of analgesic medication. C. Consult with the anesthesia healthcare provider for a prescribed dose of analgesia. D. Tell the client that pain medication cannot be given until transfer to the postoperative unit. C. Consult with the anesthesia healthcare provider for a prescribed dose of analgesia. A client who remains in the postanesthesia care unit may still have residual effects of anesthesia, so the healthcare provider should be consulted for a dose that is reduced or different than prescribed. In the prescribed clinical pathway for an elderly client who is bedridden after the repair of a broken hip, transfer to the rehabilitation unit should be implemented at 1 week postoperatively. Which intervention is most important for the practical nurse (PN) to direct the unlicensed assistive personnel (UAP) to implement to ensure the client can progress to this expected outcome? A. Encourage isotonic and active bed exercises for progressive mobilization plan. B. Provide meals and snacks high in protein to prevent muscle loss and weakness. C. Turn, cough, and deep-breathe q2 hours to prevent secretion pooling in lungs. D. Offer fluids and urinal q2 hours to maintain hydration and bladder function. C. Turn, cough, and deep-breathe q2 hours to prevent secretion pooling in lungs. An elderly client who is bedridden after orthopedic surgery is at greatest risk for hypostatic pneumonia, which can be life-threatening. Turning, coughing, and deep-breathing q2 hours is the preventive nursing measure to minimize pooling of secretions in the posterior lobes of the lungs and has the highest priority in reducing morbidity and mortality in the older population. Which task should the practical nurse (PN) assign to an unlicensed assistive personnel (UAP)? A. Check medical record for new prescriptions. B. Change dressings for a client with an infected wound. C. Toilet a client on a bladder-training regimen. D. Evaluate blood pressure for a client who has fallen. C. Toilet a client on a bladder-training regimen. Hygiene related to elimination is within the scope of a UAP. Which action should the practical nurse (PN) implement to facilitate an effective airway clearance for a client who has a stridor and is coughing while experiencing an allergic reaction? A. Turn the client to a side-lying position. B. Offer the client a glass of water to drink. C. Place the client in a high Fowler's position. D. Percuss the client's back during coughing. C. Place the client in a high Fowler's position. To ensure effective airway clearance, the client should be placed in a high Fowler's position to promote diaphragmatic excursion that helps to strengthen coughing. The practical nurse (PN) is caring for a client following aortic aneurysm resection with graft placement. Which laboratory finding should the PN report to the charge nurse immediately? A. Hematocrit 36%, hemoglobin 12 grams/dl. B. Sodium 145 mEq/L, potassium 4.0 mEq/L. C. Blood urea nitrogen 25 mg/dl, creatinine 2.0 mg/dl. D. Partial thromboplastin time 30 seconds, prothrombin time 12 seconds. C. Blood urea nitrogen 25 mg/dl, creatinine 2.0 mg/dl. Increased blood urea nitrogen (BUN) (normal 10 to 20 mg/dl) and creatinine (normal 0.6 to 1.2 mg/dl) may indicate poor renal perfusion and should be immediately reported to prevent further deterioration in renal function. A male client in a skilled nursing home has metastatic cancer and has requested comfort care only. During the day, he does not want to get out of bed because he is too tired and weak to sit in a chair. He sleeps on and off all day and night, his position is changed every 2 hours, and he is comfortable on his pain control regimen. Which action should the practical nurse (PN) implement at the beginning of the next day shift? A. Encourage client to continue activities of daily hygiene to stay active and awake. B. Assist him to sit in a chair for an hour each day and perform passive exercises. C. Assess his desire to get out of bed or remain in bed in a position of comfort. D. Awaken client during day for short time interval to facilitate nighttime sleep. C. Assess his desire to get out of bed or remain in bed in a position of comfort. A client with metastatic disease gets weaker because of cachexia related to cancer, not because of inactivity. Comfort care recognizes that the client has decided to direct his choices during the end of life experiences. The best action each day is to assess the client's strength, desire, and comfort measures of his choice. The practical nurse (PN) is obtaining a history from a client with acute glomerulonephritis (AGN). Which information should the PN ask to focus on this disease etiology? A. Long-term analgesic use. B. A history of hypertension. C. Recent streptococcal infections. D. Repeated urinary tract infections. C. Recent streptococcal infections. The comprehensive history from a client with acute glomerulonephritis should include information about recent streptococcal infections, such as strep throat, impetigo, scarlet fever. A client who had a cardiac catheterization 2 hours ago has a pressure dressing in the left groin. The practical nurse (PN) is taking vital signs q2 hours. Which additional assessment should the PN make? A. Pedal pulse. B. Apical pulse. C. Femoral pulse. D. Brachial pulse. A. Pedal pulse. Pedal pulses should be monitored q2 hours post-cardiac catheterization to ensure arterial perfusion distal to the femoral arterial access is intact. Which action should the practical nurse implement to reduce the risk of edema for a client who had a leg cast applied for a fractured tibia? A. Examine the cast for dents. B. Petal the edges of the cast. C. Elevate the newly casted leg on two pillows. D. Tell the client not to insert objects under the cast. C. Elevate the newly casted leg on two pillows. Elevating the leg to heart level using two pillows helps reduce edema formation. A client with a spinal cord injury is flushed and sweating profusely, complaining of headache and nausea, and has an elevated blood pressure with a slow pulse rate. What intervention should the practical nurse (PN) implement first? A. Notify the healthcare provider immediately. B. Check urine flow from indwelling catheter. C. Administer antihypertensive medication. D. Elevate head of the bed to a sitting position. D. Elevate head of the bed to a sitting position. The client i