6. Thez LPN/VNz isz assessingzaz patientz beforez givingz az drugz forz bloodz pressurezmanagement.z Theznursezn
90/50zmmzHg.z Whatzisztheznurse’szbestzaction?
a. Holdz thezdrugzandzreportzthezbloodz pressureztozthezRN.
b. Givezthezpatientzaz fullzglasszofzwaterzbeforezgivingzthezdrug.
c. Comez backz inz 30z minutesz andz recheckzthez bloodz pressure.
d. Havezthez patientz performzpursedz lipzbreathingz beforezgivingz thezdrug.
ANS:z A
ThezbestzactionzisztozholdzthezdrugzandzcontactzthezRN.zThezpatientzmayzneedzanzadjustmentztozthezdos
ugzorzswitchingztozanotherzdrug.zGivingz waterzwithzthezdrugzisznotzcontraindicatedzbutzdoesznotzrecogn
hypotension.zPursedzlipzbreathingzhasznozrolezinzthiszsituation.
DIF: CognitivezLevel:zRemembering REF:zzp.z4
7. Thez LPNzisz collectingz objectivez dataz forz inclusionz inzthez nursingz assessment.z Whichz piecez ofz informa
Nzhasazclearzunderstandingzofzobjectivezassessmentzdata?
a. Azpatient’szratingzofzchestzpainzasz8zonzaz1ztoz10zscale.
b. Familyz membersz reportzthatz patientz hasz beenz experiencingz painz forz1zmonth.
c. Detailedzhistoryz ofzthezpatient’szcurrentzillnessz uponzadmission.
d. Compilationz ofz pastzlaboratoryzresultszandzx-rayzreports.
ANS:z D
Thezpatient’szpastzlaboratoryzandzx-
rayzresultszarezexampleszofz objectivezdata.z Azpainzratingzofz8/10,zazfamilyzmember’szdescriptionofzthe
ofzcurrentzillnesszarezexampleszofzsubjectivezdata.
DIF: CognitivezLevel:zRemembering REF:z p.z3
8. Az patientz recentlyz beganz az takingz bloodz pressurez drugz andz presentsz forz az follow-upz appointment.z The
patient’szdailyzbloodz pressurezrecordings.zWhichzstagezofztheznursingzprocesszcorrespondsztozthiszrevi
a. Assessment
b. Planning
c. Diagnosis
d. Evaluation
ANS:z D
Thezevaluationzphasezinvolveszexaminingzthezresultszthatzoccurzwhenzthezplanziszimplemented.zReview
dzpressurezrecordingzexamineszthezpatient’szresponseztozthezdrug.zThezassessmentzphasezprovidesziniti
ient,zthezproblem,zandzanythingz thatzmayzchangezthezchoicezofztreatment.zThezplanningz phasezinvolve
atazandzdiagnosesztozsetzgoalszandz writezcarezplans.zThezdiagnosiszphasezinvolveszdecision-
makingzaboutzthezpatient’szproblems,z includingzmedicalz diagnosesz madezbyz thezhealthcarezproviderz a
opedzthroughz thezNorthz Americanz Nursingz DiagnosiszAssociationz(NANDA).
DIF: CognitivezLevel:zRemembering REF:zp.z2
9. Afterz receivingz report,zthez LPNz givesz drugsz toz herzassignedzpatientsz onz thezeveningz shift.z Withz which
ocesszdoeszthiszactivityzcorrespond?
a. Implementation
b. Assessment
c. Planning
d. Diagnosis
ANS:z A
Thezimplementationzphasezinvolvesz activelyzfollowingzthezplanzofzcarezandzaccuratelyz givingzordered
sessmentzphasezinvolveszobtainingzinitialzinformationzaboutzthezpatient,zthezproblem,zandzanythingzth
11. Az patientz iszreceivingz anz antibioticz forz pneumonia.z Onz thezthirdz dayz ofztheztreatmentz regimen,z az rashza
shezreportszitchingzandzshortnesszofzbreath.zWhichztermzdescribeszthezeffectzthatzhaszoccurred?
a. Therapeuticz effect
b. Adversez effect
c. Sidez effect
d. Overdosez effect
ANS:z B
Anzitchyzrashzwithzshortnesszofzbreathz thatzdevelopszinzresponseztozdrugziszanzexamplezofzanzallergiczr
tztozthezantibiotic.zTherapeuticzeffectszoccurzwhenzanzantibioticzfightszinfectionzwithoutzcausingzanyza
ectszofzdrugszarezknownzpotentialzeffectszofzthezantibioticz thatzrangezfromzmildztozmoderate.zAnzoverd
eceivesztoozmuchzofzazdrug.
DIF: CognitivezLevel:zUnderstanding REF:z p.z9
12. AnzLPNzenterszazpatient’szroomztozgivezazscheduledzdrug.zBeforezadministration,zthezpatientzstates,z“Iz
;z I’mzallergicztozit.”zWhatzshouldztheznursezdozfirst?
a. Reassurezthez patientz thatzthez drugzisz neededz andz observationsz regardingz possib
lezallergiczsymptomszwillzbezmade.
b. Reviewz thezpatientz recordzandz encouragez thezpatientztoztakezthezdrugzifz
nozallergieszhavezbeenzdocumented.
c. Assesszthezpatient’szallergicz historyzandznotifyzthezhealthcarezproviderzto
determinezaz coursezofzaction.
d. Documentz patientz refusalz andz leavezaznotezonzthez patientz chartz forzth
ezhealthcareprovider.
ANS:z C
Thezpatientzhaszsharedzinformationzthatzindicateszthezpotentialzforzthezorderedzdrugztozcausezadverseze
ug,ztheznursezshouldzinvestigatezfurtherzbyzobtainingzazmorezdetailedzdrugzhistoryzandznotifyingzthezhe
tezthezorder.zAlthoughzthezorderzmayzbezaccuratelyzwritten,zdeterminingz whetherzthezdrug’szbenefitszo
actionzwithinzthezlegalzscopezofztheznurse’sz practice.zTheznursezshouldznotzofferzfalsezreassurancezand
safety,zshouldzinvestigatezfurtherzbeforezgivingzthezdrug.zThezpatientzhaszraisedzconcernsz regardingzth
yzbezbroughtztozthezprovider’szattention.zAznotezonzthezchartzleaveszpotentialzforzinformationztozbez
DIF: CognitivezLevel:zApplying REF:zzp.z4
13. ThezLPNziszpreparingztozgivezthezinitialzdosezofzanzantibioticztozaz patientzdiagnosedzwithzanzinfection.z
utinzazrashzthezlastztimezIztookzthatzpill.”zWhatzactionzshouldzthezLPNztakeznext?
a. Givezthezdrugzandz checkz thez patientzinz 30zminuteszforz azrash.
b. Documentz thatzthez patientz refusedzthez drugz perzagencyz policy.
c. Leavezthezdrugzatz thezbedsidez whilezcheckingzthezchartzforzthezpatient’szallergies.
d. Notifyzthezregisteredz nursez orz healthcarezprovider.
ANS:z D
Thisziszazpossiblezadversezreaction,zandzthezRNzorzhealthcarezproviderzshouldz beznotifiedzimmediately
zthezdrugztozseezifzitzdoeszcausezazrash.zDrugzshouldzneverzbezleftzatzthezbedside.zThezpatientzdidznotz
DIF: CognitivezLevel:zApplying REF:z p.z9
14. Whichzpriorityz assessmentz mustzyouzmakezbeforezgivingz anyzpatientzazdrugzbyz mouth?
a. Quizzthezpatientz aboutz thezactionz ofzeachzdrug.
b. Makezsurezthezpatientzcanz swallow.
c. Findz outz whetherz thezpatientz prefersz coldz orz roomz temperaturezliquids.
d. Askzthezpatientztozrepeatzhisz orzherz namezandz birthdate.
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