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An older client with metastatic breast
cancer is experiencing shortness of
• Instructions for care should be included
breath as a result of a bilateral pneumo-
in the clients living will
nia the client
• Care can be provided in home where
has a living will and the family is re-
client resides
questing hospice care which information
• Care focuses on comfort dignity and
should the practical nurse (PN) reinforce
emotion support
with the
client and family regarding hospice?
An older female client adult who has
been admitted to long term facility yes-
terday is confused about what day of the
Remind the client what day of the week
week it is
it is
her history does not include that she was
confused prior to admission what action
should the practical nurse (PN) take?
A client who is primigravida at herm to
the prenatal clinal and tells the practical
nurse (PN) that she is having contrac-
tions every
5 minutes the PN monitors the clint for
an hour using external fetal monitor and Send the client home
determines that the clients contractions
are 7
to 15 minutes apart lasting to 20 to 30
seconds with mild intensity by palpitation
which actin should the PN take?
A client who is a gravida 1 para 0 is
transferred to the recovery room follow-
ing a normal vaginal delivery of a healthy
Apply light warm blanket and assure her
newborn
that this is normal following delivery
the practical nurse (PN) observes that
the client is shaking uncontrollably and
states she's cold
The practical nurse (PN) is assessing an
older client with left sided heart failure Auscultate all the lung fields
what intervention is most important for
, Exit HESI PN
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the PN
to implement
While administering prescription med-
ication to an older adult resident in a
extended care facility the practical nurse
Determine if client has had difficulty
notice that
hearing in the past
the client is having difficulty hearing what
action is most important for the PN to
take?
The healthcare provider Gives a preg-
nant woman a prescription for one pre-
natal vitamin with iron daily and tells her
that she
needs to increase iron rich foods in • Add lenhl and black beans
her diet because her hemoglobin is 8.2 • Increase green leafy vegetables in the
gramsldi when a list of iron list foods is diet
given to the • Oatmeal is a good choice for breakfast
client the client tells the practical nurse
she's a vegetarian and does not eat
bleeds what instructions should the PN
give?
A full term 24 hour old infant in the nurs-
ery regulates and suddenly turns cyanot-
ic which immediate interventions should Turn the infant to the right side
the
practical nurse (PN) take?
The practical nurse (PN) views the mid-
line episiotomy of a client who repots
Observe suture line for separation and
pain in her stiches whar action should
hematoma formation
the action
should the PN take first?
The practical nurse (PN) is obtaining fe-
tal heart rates on four antepartum client
in their third trimester of pregnancy what
180 (NORMAL 110-160)
fetal
heart rate should be reported to the reg-
istered nurse?
, Exit HESI PN
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An older client who had a colon resection
8 days ago is straining at stool the prac-
tical nurse (PN) observes from the client
Evisceration
klound followed by appearance of bowel
on the skin which complication has oc-
curred?
A female client with immune thrombocy-
topenic purpura is transported to a long
term facility for physical therapy rehabili- Ensure the client has minimum clutter in
tation the room
to prevent injury the most important for
the practical nurse (PN) to implement?
Which location should the practical
nurse palpate to determine if a client
Beneath the lower jaw
submandibular lymph node are en-
larged?
A client is receiving an epidural anesthe-
sia during labor which observation is the
most important adverse effect that the
Maternal hypotension
practical nurse (PN) should assess for
following the administration of the epidur-
al
The practical nurse (PN) is working in a
cancer detention mobile clinic. Four indi-
viduals come for screening with a com-
plaint of
hoarseness a danger sign for cancer of A older male who drinks a 6 pack of beer
the larynx which client has the highest nightly and smokes heavily
risk of development of cancer of the lar-
ynx that
the PN should refer to healthcare
provider
A home health practical nurse (PN) visits
and older client living with offspring who
Report suspected abuse to supervisor
exhibits fear unkempt and has lost a lot
and protective services
of
weight which action should the PN take
, Exit HESI PN
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The practical nurse determines that a
client who is one day postpartum has
a moderate amount of lochia and rubra
and the Massage the uterus to decrease atony
uterus is firm diverted and three finger
breaths above umbilicus what should be
the first initial action
The practical nurse is caring for a client
with coronary artery disease who is ad-
mitted intermitted chest pain the admis-
sions
lobotomy results indicated elevated The labs results indicate myocadiac
tropine 1 and creatine phosphoicinase damage and the client is at risk for car-
myoglobulin isoenzymes levels what diac dysrhythmias
should the PN
consider the most significant risk is for
this client on the second day of admis-
sions?
Which interventions should thr practical
nurse (PN) reinforce for a client with pru- Keep finger nails trimmed short
ritis?
When gathering data about a client with
dark skin tones which site should the Finger and toe nails
practical nurse (PN) observe
A 2 day old infant with hydrocephalus re-
turns from surgery following placement
• Document strict intake and out take
of a ventriculoperitoneal shunt which
• Measure head circumference
nursing
• Monitor body temperature every 4
intervention should the practical nurse
hours
(PN) implement during postoperative
care
The birth weight of an infant delivered
by a woman with gestational diabetes is
10.1 pounds the infant is jittery and has
Offer nipple feedings of 10% dextrose
a heel
stick glucose level of 40 30 minuets af-
ter birth based on this information which
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