LPN Nursing Fundamentals

LPN Nursing Fundamentals Related

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A client's wife has been informed by the physician that her spouse has a permanent C2-C3 spinal injury, which has resulted in permanent quadriplegia. The wife states that she does not want the physician or nursing staff to tell the client about his injury. The client is awake, alert, and oriented when he asks his nurse to tell him what has happened. The nurse has conflicting emotions about how to handle the situation and is experiencing:

  • A. autonomy.
  • B. moral distress.
  • C. moral doubt.
  • D. moral courage.
Correct Answer: B

Rationale: The nurse's conflict between truth-telling and the wife's request is moral distress (B), feeling unable to act ethically. Autonomy (A) is patient rights. Doubt (C) is uncertainty. Courage (D) is acting despite fear. B is correct. Rationale: Moral distress arises from ethical dilemmas, common in nursing when values clash, per ethics frameworks, requiring resolution.

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Whitney verbalizes that she is anxious that the diagnostic test might reveal laryngeal cancer. Which of the following is the most appropriate nursing intervention?

  • A. Tell the client not to worry until the results are in
  • B. Ask the client to express feelings and concern
  • C. Reassure the client everything will be alright
  • D. Advice the client to divert his attention by watching television and reading newspapers
Correct Answer: B

Rationale: Asking Whitney to express feelings (B) is most appropriate, fostering therapeutic communication, per Rogers. 'Don't worry' (A) and 'everything's alright' (C) dismiss anxiety. Diversion (D) avoids emotions. B addresses her fear, making it correct.

After having an I.V. line in place for 72 hours, a patient complains of tenderness, burning, and swelling. Assessment of the I.V. site reveals that it is warm and erythematous. This usually indicates:

  • A. Infection
  • B. Infiltration
  • C. Phlebitis
  • D. Bleeding
Correct Answer: C

Rationale: These symptoms indicate phlebitis, inflammation of the vein.

The nurse is caring for a client with a tracheostomy tube who is receiving mechanical ventilation. The nurse is monitoring for complications related to the tracheostomy and suspects tracheoesophageal fistula when which occurs?

  • A. Suctioning is required frequently.
  • B. Aspiration of gastric contents occurs when suctioning.
  • C. The client's skin and mucous membranes are light pink.
  • D. Excessive secretions are suctioned from a tracheostomy.
Correct Answer: B

Rationale: Tracheoesophageal fistula (TEF), a rare tracheostomy complication, involves an abnormal connection between trachea and esophagus. Aspiration of gastric contents during suctioning (B) is a definitive sign, indicating esophageal leakage into the airway. Frequent suctioning (A) or excessive secretions (D) are nonspecific. Pink skin (C) reflects good oxygenation, not TEF. B is correct. Rationale: TEF allows gastric contents to enter the trachea, detected during suctioning, requiring urgent intervention like tube adjustment or surgery, distinct from routine secretion issues, per critical care nursing.

Which statement best describes the effects of immobility in children?

  • A. Immobility prevents the progression of language and fine motor development
  • B. Immobility in children has similar physical effects to those found in adults
  • C. Children are more susceptible to the effects of immobility than are adults
  • D. Children are likely to have prolonged immobility with subsequent complications
Correct Answer: B

Rationale: Children experience similar physical immobility effects as adults, like atrophy and demineralization.

When should the client test his blood sugar levels for greater accuracy?

  • A. During meals
  • B. In between meals
  • C. Before meals
  • D. 2 Hours after meals
Correct Answer: C

Rationale: Before meals e.g., fasting glucose offers accurate baseline sugar levels, unlike during (eating), between (variable), or post-meal (spike). Nurses advise this e.g., AM checks for diabetes monitoring, per endocrinology standards.

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