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Two hours after the insertion of a Salem sump nasogastric (NG) tube, the client vomits a moderate amount of yellow-green fluid. What is the most appropriate action for the LPN/LVN to take?
- Inject 30 mL air and auscultate the left upper quadrant.
- Instill 20 mL carbonated beverage into the drainage tube.
- Inform the primary health care provider of the vomiting.
- Irrigate nasogastric (NG) tube with 20 mL normal saline.
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The LPN/LVN is caring for a client after a motor vehicle accident. The LPN/LVN observes that the client is restless, anxious, and has tremors of the hands. The family reports that the client has consumed 4 to 6 beers a day for the past 8 years. What is the priority action for the LPN/LVN to take?
- Reorient client to the environment frequently.
- Maintain the client in a cool, darkened room.
- Assist the client to drink more isotonic fluids.
- Administer thiamine 100 mg intramuscularly.
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The LPN/LVN is preparing to administer isoniazid 300 mg PO. Which of the following is a priority laboratory value to monitor before administering the medication?
- B-type natriuretic peptide (BNP).
- Aspartate aminotransferase (AST).
- Potassium.
- Vitamin B12.
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The LPN/LVN is reinforcing instructions for a client taking clopidogrel 75 mg PO daily. Which statement by the client indicates understanding of the reinforced instructions?
- “It will be necessary for me to have frequent blood tests done now.”
- “I will need to discontinue the garlic tablets I take to control cholesterol.”
- “I can continue to take several ibuprofen a day for my low back pain.”
- “I will need to make sure I take a daily multivitamin tablet now.”
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The LPN/LVN is caring for a child whose parent reports that the child experienced abdominal cramps and diarrhea after ingesting milk. Which of the following test results would rule out the diagnosis of lactose intolerance?
- Random serum glucose level 20 mg/dL (1.1 mmol/L) greater than the fasting serum glucose level.
- Random serum glucose level 20 mg/dL (1.1 mmol/L) less than the fasting serum glucose level.
- Fasting serum glucose level results are equal to the random serum glucose level results.
- Fasting serum glucose level 10 mg/dL (0.56 mmol/L) greater than the random serum glucose level.
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The LPN/LVN is preparing a primigravid client for a primary health care provider examination. Laboratory test results are available. Which fasting serum glucose level result would indicate that gestational diabetes is likely?
- Serum glucose level of 40 mg/dL (2.2 mmol/L).
- Serum glucose level of 100 mg/dL (5.5 mmol/L).
- Serum glucose level of 140 mg/dL (7.7 mmol/L).
- Serum glucose level of 180 mg/dL (9.9 mmol/L).
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The primary health care provider prescribed phenytoin 100 mg PO q.i.d. for the client. Prior to administering the second dose, the LPN/LVN observes that the client appears lethargic and has nystagmus and slurred speech. In addition to notifying the supervising RN, the LPN/LVN should do which of the following?
- Administer the phenytoin to prevent an impending seizure.
- Administer the phenytoin to prevent cardiac arrhythmia.
- Withhold the phenytoin due to signs of an allergic reaction.
- Withhold the phenytoin because client show signs of toxicity.
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The LPN/LVN is reviewing medication information with a female client who has been prescribed sertraline daily. Which of the following statements by the client indicates a need for further instruction?
- “I will continue to take my birth control pills.”
- “If these pills don’t work in 2 weeks, I will stop taking them.”
- “I will take my pill first thing in the morning.”
- “I will skip a missed dose if it is almost time for my next one.”
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Within 5 minutes of beginning a blood transfusion, the client reports feeling hot and diaphoretic, and the LPN/LVN observes that the client appears flushed. Which of the following actions should the nurse take first?
- Notify primary health care provider.
- Stop blood transfusion immediately.
- Increase normal saline solution drip rate.
- Obtain the client's vital signs immediately.
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The client comes to the urgent care clinic reporting “I’ve just stepped on a rusty nail at a construction site.” The LPN/LVN observes a deep puncture wound on the sole of the right foot. What order would the nurse expect to receive from the primary health care provider for this client?
- Complete blood count.
- Wound culture.
- Tetanus vaccine.
- Lumbar puncture.