LPN Weekend Test 1

1- Add subPrior to the beginning of a site survey, the charge nurse advises the nurse to deny any knowledge of a recent sentinel event if asked by the surveyor. Which action will the nurse take? 1- Notify the unit manager. 2- Notify the medical director. 3- Tell the charge nurse about being uncomfortable lying to the surveyor. 4 -Tell the surveyor the nurse is not allowed to talk to them. 2- The nurse is providing care for several clients that arrived at the urgent care clinic at the same time. Which client will the nurse assess first? 1- 16-year-old with a severe headache, fever, and stiff neck. 2- 30-year-old with a fever, vomiting and diarrhea. 3- 66-year-old with a swollen, bruised knee reporting severe pain. 4- 41-year-old with severe burning with urination, fever, and chills. 3- A client, who takes medication for hypertension, develops a cough. Which medication will the nurse suspect as the cause for the cough? 1- Losartan. 2- Lisinopril. 3- Nifedipine. 4- Propranolol. 4- The nurse provides care for a client with diabetes insipidus (DI). Which nursing diagnosis is most appropriate for this client? 1- Fluid volume deficit related to excess urine output. 2- Hyponatremia related to increased sodium excretion. 3- Risk for fluid overload related to low urine output. 4 -Hyperglycemia related to reduced insulin production. 5- The nurse performs a newborn assessment. Which finding does the nurse report to the health care provider? 1- Pink patch on the nape of the neck. 2- Bluish skin over the sacral and gluteal area. 3- An axillary temperature of 97.8°F (36.2°C). 4- A respiratory rate of 26 breaths per minute. 6- The nurse reviews care needed for a client recovering from surgery. Which task does the nurse delegate to nursing assistive personnel (NAP)? (Select all that apply.) 1- Apply antiembolic stockings. 2- Measure height and weight. 3- Instruct how to perform breathing exercises. 4- Use a bladder ultrasound to check for urinary retention. 5- Assist in removing a leg prosthesis. 7- The nurse develops a dietary teaching plan for a pregnant client. Which information will the nurse include? 1- Protein requirements will triple. 2- The need for calories will increase by 1200 kcal/day. 3- There is an increased need for iron. 4- Sodium needs will decrease. 8- The nurse provides care to a newly admitted client. Which action is the best example of a culturally appropriate nursing intervention? 1- Insist that family members provide most of the client’s personal care. 2- Ask permission before touching the client during the physical assessment. 3- Maintain a personal space of at least 3 feet when assessing the client. 4- Consider the client’s ethnicity as the most important factor in planning care. 9- The oxygen saturation level of a client with lung cancer drops from 93% to 86% during ambulation. Which action does the nurse take next? 1- Continue ambulation, as this is a normal response to activity among lung cancer clients. 2- Move the oximetry probe from the finger to the earlobe for accurate monitoring during activity. 3- Obtain a prescription for supplemental oxygen to be used during ambulation and other activity. 4- Request a prescription for arterial blood gases to verify the arterial oxygen saturation. 10- The nurse is preparing to move a client from the bed to a wheel chair. Which technique does the nurse use to ensure proper body mechanics? (Select all that apply.) 1- Create a wide stance with one foot forward and one back. 2- Use back muscles when lifting client to a standing position. 3- Stand between the client and the wheelchair. 4- Hold client at arm's length when standing. 5- Pivot toward the wheelchair using leg muscles. 11- The nurse provides care for a client diagnosed with a myocardial infarction who is prescribed non-enteric-coated aspirin. Which action does the nurse take in this situation? 1- Give the aspirin with water via a nasogastric (NG) tube. 2- Request a blood type and cross-match for transfusion. 3- Determine if there is a history of peptic ulcer disease. 4- Obtain a 12-lead electrocardiogram (ECG) prior to aspirin administration. 12 - The nurse provides care for a client admitted with left sided paralysis and impaired speech. Which nursing diagnosis should the nurse assign the highest priority for this client? 1- Impaired swallowing. 2- Risk for injury. 3- Self-care deficit. 4- Ineffective coping.