An older adult client tells the home health practical nurse (PN) of not having any money, and a belief of not deserving to eat, so the client has not asked anyone to help provide food. Which information is most important for PN to obtain?

Community resources to provide financial aid.

Availability of family members to provide meals.

Medication history for antipsychotic agents.

Client thoughts about wanting to hurt himself.

Answer and Explanation

The Correct Answer is D

A. Community resources to provide financial aid: This is important for long-term support but does not address the urgent need to assess for suicidal intent in a client expressing hopelessness and self-neglect.
B. Availability of family members to provide meals: Relevant for nutritional support planning, but not the priority when the client has expressed feelings of worthlessness.
C. Medication history for antipsychotic agents: Could identify causes of decreased appetite or mood, but it is not the first priority.
D. Client thoughts about wanting to hurt himself: Expressions of not deserving to eat and hopelessness may indicate suicidal ideation; assessing for self-harm risk takes priority for client safety.

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Correct Answer is ["C","D","F"]

Explanation

A. 1700:
Before dinner tray arrives.

B. 1400:
Too early relative to the next meal; not correct timing.

C. 0800:
Before breakfast tray at 0900.

D. 1600:
Too early for 1700 meal; may reduce medication effectiveness before eating.

E. 1800:
After meal - incorrect for “before meals” order.

F. 1100:
Before 1200 lunch tray.

A. Encourage the client to resume normal activities after medication administration. B. Implement ongoing assessments for signs of shallow or slow breathing. C. Assess the skin daily for areas of ecchymosis or other signs of bleeding. D. Observe the client for involuntary movements of the lips and tongue.

Correct Answer is B

Explanation

A. Encourage the client to resume normal activities after medication administration:
Activity should be limited until pain is controlled and healing is adequate.

B. Implement ongoing assessments for signs of shallow or slow breathing:
Hydrocodone/acetaminophen is an opioid combination; opioids can cause respiratory depression, requiring monitoring.

C. Assess the skin daily for areas of ecchymosis or other signs of bleeding:
This is not the primary concern for an opioid; bleeding risk is not significant unless the client is on anticoagulants.

D. Observe the client for involuntary movements of the lips and tongue:
This relates to tardive dyskinesia, associated with antipsychotics, not opioids.

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An older adult client tells the home health practical nurse (PN) of not having any money, and a belief of not deserving to eat, so the client has not asked anyone to help provide food. Which information is most important for PN to obtain?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a prescription for a medication to be administered three times a day before meals. The food trays arrive on the unit at 0900, 1200, and 1700. At what times should the practical nurse administer the medication? Select all that apply.

Correct Answer is ["C","D","F"]

Explanation

The practical nurse (PN) is caring for a client with fractured metatarsals after slamming a hand in the car door. After administering the prescribed hydrocodone/acetaminophen for pain, which intervention should the PN include in the client's care?

Correct Answer is B

Explanation

The practical nurse (PN) determines that a client's pupils constrict as they change focus from a far object to a near object. How should the PN document this finding?

A client with end stage chronic obstructive pulmonary disease (COPD) is anxious with labored respirations, increasing dyspnea when attempting to talk, and reports a painful cough. Which intervention should the practical nurse (PN) implement?

The practical nurse (PN) is assigned to care for a client that is unconscious and at risk for aspiration. The PN prepares to provide oral care to the client. Which action should the PN take next?

A client has partial thickness burns to both arms. After medicating the client with an opioid analgesic, the practical nurse (PN) changes the sterile dressings. Which action is most important for the PN to implement before applying silver sulfadiazine cream to the burn lesions?

The practical nurse (PN) is caring for a client with obstructive sleep apnea (OSA). The PN should recognize the client is at greater risk for the development of which complication?

The parent of an school-aged child tells the practical nurse (PN) that the child fell out of a tree and hurt the child's arm and shoulder. Which assessment finding should the PN note as the most significant indicator of possible child abuse?

A male client who is agitated is gesturing at the television in the day room and talking to an empty chair. Which interventions should the practical nurse (PN) implement? Select all that apply.