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Adapting Interventions to the Care Method

1. An LPN who works in the surgery unit must perform a capillary glycemia on a 62-year-old patient who is allergic to disinfectants. The steps for performing a capillary glycemia are presented out of order below.
1. Apply a compress to the puncture site
2. Wash the patient’s hands with warm water
3. Record the test results in the patient’s file
4. Massage the puncture site
5. Put on non-sterile gloves

Select the order in which the procedure should be performed. *
2. A beneficiary living in a CHSLD has developed a left lateral malleolus wound. Since the beneficiary is an MRSA carrier, the RN asks that additional contact precautions be taken. The physician has prescribed a wound culture. When the LPN removes the old dressing, she notes the presence of purulent exudate. She performs the wound culture and applies a new dressing. The steps for collecting a sample for a wound culture are presented out of order below.
1. Put on non-sterile gloves
2. Put on sterile gloves
3. Put on a long-sleeved gown
4. Clean the wound and collect the sample
5. Place the beneficiary in the right lateral decubitus position

Select the order in which the procedure should be performed. *
3. An LPN working in a CHSLD must perform tracheostomy care on a 55-year-old beneficiary using a disposable inner cannula. The steps for providing tracheostomy care are presented out of order below.
1. Remove and dispose of the inner cannula
2. Gently insert the inner cannula into the outer cannula
3. Open the latch and unlock the inner cannula
4. Perform proper hand hygiene and put on sterile gloves
5. Remove the soiled tracheostomy dressing

Select the order in which the procedure should be performed. *
4. A patient has been hospitalized for diverticulitis. He says he feels a swelling in his stomach accompanied by cramps. He is anxious because of the paraclinical exams he underwent this morning. Given the patient’s condition, the physician gives the following prescription:
-Analgesic (acetaminophen) 650 mg PO q4h PRN 325 mg/co if abdominal pain
-Anxiolytic (clonazepam) 0.5 mg PO STAT 0.5mg/co.
-Rectal tube STAT Upon insertion of the rectal tube, the patient develops diaphoresis, and becomes pale and agitated.

Upon insertion of the rectal tube, the patient develops diaphoresis, and becomes pale and agitated. The steps for the inserting a rectal tube are presented out of order below.
1. Stop the insertion
2. Insert the rectal tube 10 cm into the anus
3. Lubricate the proximal end of the rectal tube
4. Place the patient in the left lateral decubitus position
5. Take the vital signs

Select the order in which the procedure should be performed. *
5. A hospitalized patient in the cardiology unit is receiving anticoagulant therapy. The LPN prepares to take a blood sample by venipuncture at the crease of the patient’s left elbow. The patient said he doesn’t like needles at all and that he often gets bruises on his arms. Which of the following interventions is most appropriate for promoting hemostasis? *
6. A patient is hospitalized for hyperthermia. The patient has bladder cancer and uses a urinary catheter. Her urine is orange and cloudy, and gives off a strong, foul-smelling odor. The patient is calm and cooperative while receiving care. The LPN must collect a sample for a blood culture. Everything goes well with the first bottle, but the LPN is unable to obtain the necessary amount of blood for the second one. In fact, she is only able to collect a few drops at first, but no more afterwards. She repositions the needle, but to no avail. Which of the following actions must be carried out by the LPN? *
7. A beneficiary with Alzheimer’s dementia is very agitated and confused. She fell out of her bed during the night, and the physician has therefore prescribed a magnetic abdominal restraint for when she is in bed. The LPN who works at night installs the beneficiary’s restraint for the first time, as prescribed, and ensures follow-up. What would be the appropriate follow-up? *
8. A patient is hospitalized in the neurological unit for epileptic seizures. The LPN must change the short intravenous catheter of less than 7.5 cm that has been in place for three days, as instructed by the care plan. While removing the transparent film dressing, the LPN notices a significant redness and slight edema on the skin at the exact location of the dressing. The patient feels no pain and says that the redness and edema are normal, since her skin always reacts to dressings. What would be the appropriate follow-up? *
9. An LPN providing common services at a CLSC must administer an influenza vaccine. A client arrives and says that the last time she received a vaccine, she had respiratory problems afterwards. She also tells the LPN that she often gets allergic reactions. What would be the appropriate follow-up? *
10. A 75-year-old patient is hospitalized in the surgery unit for a left hip arthroplasty. He has a history of heart problems and must comply with a fluid restriction of 1L per day. He is on his third day post-op, and his urinary catheter was removed this morning at 6:00 am. It is now 2:00 pm, and the patient has not urinated nor felt the urge to do so. What would be the appropriate follow-up? *
11. A patient has been hospitalized in the medical unit for the past week. He is suffering from chronic bronchitis and pneumonia. At 8:00 am, the patient feels pain in his rib cage rated at 6/10. He then receives 1000 mg of non- narcotic analgesic. His vital signs are the following: BP at 155/90, pulse at 90 bpm, resp. at 18 bpm, SpO2 at 92%, and buccal temperature at 38.2. at 9:00 am, the LPN observes that the patient has dyspnea, upon strain. She takes the patient’s vital signs, which are as follows: BP at 140/78, pulse at 74 bpm, resp. 24 bpm, SpO2 at 86%, buccal temperature at 38.4, and a pain rate 6/10. After verifying the documents and receiving authorization from the RN, the LPN reinstalls 1.5L of O2 via nasal cannula. What would be the appropriate follow-up? *
12. An 8-year-old patient received an operation this morning for reduction of a double fracture in his right leg. It is 5:30 pm, and the young patient is becoming increasingly agitated. He moves a lot, says he has a sore leg, and asks that his cast be removed. The LPN collects the patient’s data and notes the following: BP at 124/80, pulse at 104 bpm, resp. at 18 bpm, and SpO2 at 98%. The boy responds well to questions, but has numbness in his right leg. His pupils are reactive and symmetrical. Which of the following signs shown by the patient indicated a neurovascular complication? *
13. A 68-year-old snowmobiler has been hospitalized for two days following a collision with another snowmobiler. He had ended up in a ditch, stuck under his snowmobile for several minutes. He fractured his right femur and his pelvis, and is now on bed rest. At 10:00 am, while monitoring the patient’s NVS, the LPN collects the following data: RLE LLE

At 2:00 pm, the LPN monitors the patient’s NVS once again, and collects the following data: RLE LLE

Which of the following signs indicates a neurovascular complication? *
14. In the rehabilitation unit, a patient is recovering from a stroke on the left side of the brain. She has expressive aphasia, right hemiparesis, and unilateral spatial neglect. Her pupils are reactive and normal, and she possesses good muscular strength in both and lower left extremities. It is 6:00 am, and the LPN collects the patient’s blood samples. She notices that the patient’s mouth is deviated to the left and that the patient feels drowsier than she did yesterday. The patient opens her eyes as a reaction to verbal stimuli, but closes them within seconds. The LPN verifies the patient’s neurological signs and collects the following data: – Left pupil fixed in mydriasis, right pupil reactive and normal – RUE no reaction – LUE average muscular strength – RLE no reaction – LLE average muscular strength The LPN immediately notifies the RN. Which of the following signs shown by the patient indicates a neurological complication? *
15. A 7-month-old infant is hospitalized after off his changing table. The LPN observes significant bruising on the baby’s front and around his eye sockets. The baby cries when the LPN performs a venipuncture. His pupils are uneven, and slow to react. The physician asks that the infant’s neurological signs be monitored for the next 24 hours. Which of the following signs shown by the patient indicates a neurological complication? *
16. A 65-year-old client with a history of diabetes and high blood pressure receives treatment at home for an ulcer on her right foot and cellulitis at the bottom of her right leg. During the last few visits, her vital signs were normal. The client is currently taking the following medications: a hypoglycemic, an antihypertensive beta- blocker, and angiotensin-converting enzyme (ACE) inhibitor, a thiazide diuretic, and an antibiotic. The LPN visits the client every day to take her vital signs. Today, the results are the following: BP at 90/56, pulse at 94 bpm, resp. at 20 bpm, SpO2 at 96%, and buccal temperature at 37.2. While the LPN is reapplying the dressing, the client says that she feel pain in her right leg. Which of the following possible complications are indicated by the client’s vital signs? *
17. A patient with lung cancer is hospitalized for an infection. For the past few weeks, she has been taking anticoagulants and corticosteroids. She also gets headaches, and has gained five pounds in a way that gives her a swollen appearance. The physician has prescribed IM antibiotics. At 9:00 am, the LPN takes the patient’s vital signs, which are as follows: BP at 170/90, pulse at 80 bpm, resp. at 18 bpm, SpO2 at 96%, and buccal temperature at 37.5. What is the main reason for the patient’s unbalanced vital signs? *
18. An LPN visits a 75-year-old who recently moved into a private seniors’ residence. The man used to live alone, but ever since his wife died a year ago, his independence has diminished considerably. He says he does not know how to cook, so he’s been buying prepared meals and canned food. He has put on 25 kg over the past few months, and now weighs a total of 95 kg at a height of 1.7 metres. He used to smoke four to five cigarettes a day, but now he smokes almost one pack a day. The patient becomes dyspneic at the slightest effort and the LPN observes significant edema at the ankles. The physician asked the LPN to visit the client weekly to take his vital signs and monitor his breathing. This morning, the LPN collects the following data: BP at 130/88, pulse at 88 bpm, wheezing at 24 bpm, SpO2 at 95%, and buccal temperature at 36.4. Which of the following possible complications are indicated by the client’s vital signs? *
19. Mme Lucie Tremblay, 57 years old, is being treated for a postoperative wound on her lower abdomen. The incision was partially opened by the surgeon to allow drainage. During the dressing change, the LPN removes the old wick and notes moderate serosanguinous drainage in the wound cavity. The medical order reads: “Saline-moistened wick dressing, ensure drainage tail remains visible.”

After preparing sterile supplies, the LPN moistens a sterile gauze strip with saline and gently inserts it into the wound cavity using sterile forceps.

When completing the wick dressing, what should the LPN do? *