Mosby's Prep Guide for the Canadian PN Exam PDF

Mosby's® Prep Guide for the Canadian PN Exam Practice Questions for Exam Success FIRST EDITION Marianne Langille, RN, BScN, MEd Fanshawe College, London, ON Karen Katsademas, RN, BScN, MN Fanshawe College, London, ON Table of Contents Title page You’ve Just Purchased More Than a Textbook! Copyright Dedication Preface Acknowledgements Reviewers 1. Introduction Background to the Canadian Practical Nurse Licensure Examinations—REx-PN and CPNRE How to use this Book 2. Description of the Canadian Practical Nurse Licensure Examinations—REx-PN and CPNRE REx-PN and CPNRE Entry-To-Practice Competencies Multiple-Choice Questions 3. Study and Exam Tips Study Tips Managing Stress Tips The Evening Before The Exam Content to Study Tips for Writing Multiple-Choice Exams Computer Adaptive Testing Summary 4. Practice Exam 1 Instructions for Practice Exam 1 Case-Based Questions Independent Questions 5. Answers and Rationales for Practice Exam 1 Case–based questions answers and rationales Independent Questions Answers and Rationales 6. Practice Exam 2 Instructions for Practice Exam 2 Case-Based Questions Independent Questions 7. Answers and Rationales for Practice Exam 2 Answers Exam 2 Independent Questions Answers and Rationales 8. Practice Exam 3 Instructions for Practice Exam 3 Case-Based Questions Independent Questions 9. Answers and Rationales for Practice Exam 3 Case–Based Questions Answers and Rationales Independent Questions Answers and Rationales Bibliography Appendix. Entry-Level/Entry-to-Practice Competencies for Licensed/Registered Practical Nurses in Canada Assumptions Scoring Sheets Canadian PN Exam You’ve Just Purchased More Than a Textbook! Copyright MOSBY'S® PREP GUIDE FOR THE CANADIAN PN EXAM: PRACTICE QUESTIONS FOR EXAM SUCCESS ISBN: 978-0-323-75914-4 Copyright © 2022 by Elsevier, Inc. All rights reserved. Adapted from Mosby’s Prep Guide for the Canadian RN Exam: Practice Questions for Exam Success, Second Edition by Janice Marshall-Henty et al. Copyright 2011 by Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 978-1- 926648-29-3 (softcover) All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Reproducing passages from this book without such written permission is an infringement of copyright law. Requests for permission to make copies of any part of the work should be mailed to: College Licensing Officer, access ©, 1 Yonge Street, Suite 1900, Toronto, ON M5E 1E5. Fax: (416) 868-1621. All other inquiries should be directed to the publisher www.elsevier.com/permissions. Every reasonable effort has been made to acquire permission for copyrighted material used in this text and to acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s attention will be corrected in future printings. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress: Control Number: 2021937142 Managing Director, Global ERC: Kevonne Holloway Senior Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-Millman Director, Content Development: Laurie Gower Content Development Specialist: Theresa Fitzgerald Publishing Services Manager: Shereen Jameel Senior Project Manager: Umarani Natarajan Design Direction: Bridget Hoette Last digit is the print number: 9 8 7 6 5 4 3 2 1 Dedication Marianne Langille and Karen Katsademas We dedicate this book to practical nursing students as they prepare for their examinations. Preface Mosby’s® Prep Guide for the Canadian PN Exam has been developed to provide practical nursing students with practice exams to aid in the preparation of completing the licensure exam. As nursing educators, we recognize that students not only require a broad knowledge of nursing theory, but they also need to feel confident answering the particular type of questions found on the licensure exam. For many, the problem is not a lack of nursing knowledge but rather a lack of ability to apply their knowledge in the exam situation. You have probably purchased this text for the practice exams, but don’t skip over the chapters on exam descriptions and tips for writing questions. They provide valuable guidelines for mastering multiple-choice questions. Most students in their respective nursing education programs have not had sufficient experience with the specific format of the questions found on the licensure exam. The licensure exam is unique in several important ways: There is a high ratio of critical-thinking questions, where all options may be correct but one of the options is the most correct. Or many different aspects of a situation must be analyzed in order to select the most appropriate answer. This problem-solving process may be difficult for students who are used to cramming the night before an exam and then regurgitating memorized facts the next day. Most questions incorporate scope of practice, asking what the nurse would do in a particular situation, rather than testing knowledge of medical treatments. Questions are written within the framework of practical nursing practice in Canada. Most available review texts are published in the United States and are based on the National Council Licensure Examination for Practical Nurses (NCLEX-PN), which does not test the Canadian practical nurse competencies. Questions included in this book are based on the 2020 entry-level/entry-to-practice competencies for practical nurses. They have been authored to include preventive and primary health care, teaching and learning, professional practice, therapeutic relationships, and current developments in health care. Each question has been authored by nursing experts, reviewed by nursing experts, and referenced to established resources. This prep guide includes three complete practice exams. Each exam consists of 200 case and independent questions, for a total of 600 questions in the three exams. For each question, there is an explanation of why the incorrect answers are incorrect and why the correct answer is correct. You may want to write the first exam as a “diagnostic,” to identify areas of weakness and get a feel for the exams. We recommend that for one of the exams, you, either by yourself or with a group of fellow students, approach it as a mock exam situation. Pretend that it is the real exam, prepare as you would for the actual day, and write the practice exam in a 4-hour time frame. This book is intended to prepare candidates for the Canadian Practical Nurse Registration Exam (CPNRE) and those candidates in BC and ON who will be writing the Regulatory Exam-Practical Nurse (REx-PN) beginning in 2022. Although limited information about this new exam is available, we have included what is known at the time of this writing. Evolve Resources for Mosby’s® Prep Guide for the Canadian PN Exam, Second Edition are available to enhance student learning. Students have the option to use the Study Mode or Exam Mode to practice and perfect their understanding of the fundamental competencies. Three Practice Exams, along with Answers and Rationales from the core text Additional Practice Questions: 100 multiple choice questions with answers and rationales Practice Questions for the REx-PN Exam: 300 questions with answers and rationales; the question types include multiple choice, multiple response, and fill- in-the-blank calculation Printable Scoring Sheets to use with the Practice Exams Acknowledgements We would like to acknowledge and thank the following individuals for their time, support and expertise in the preparation of the text: Roberta Spinosa-Millman, Senior Content Strategist (Canada) and Theresa Fitzgerald, Content Development Specialist of Elsevier. We would like to recognize the contribution of Janice Marshall-Henty and Jonathon Bradshaw, authors of Mosby's Prep Guide for the Canadian RN Exam. Their original work served as a foundation for our writing and set the standard of excellence we conscientiously followed. Reviewers Natasha Fontaine, RN, BN, PID, Program Coordinator School of Nursing College of the Rockies Cranbrook, BC Cindy Pallister, RN, BScN, MScN, Nursing Professor, Simulationist Department of Nursing St. Clair College Chatham, ON Sandra Parker, RN, BScN, MA Ed-CC, Nursing Instructor-PND Program Faculty of Continuing Education Seneca College Toronto, ON Trina Propp, RN, BSN, Nursing Instructor Department of Health Sciences-Nursing Program Vancouver Community College Vancouver, BC Valerie Sokolowski, RN, MN, Faculty Practical Nursing College of New Caledonia Prince George, BC Introduction Background to the Canadian Practical Nurse Licensure Examinations—REx-PN and CPNRE To practise as a practical nurse in Canada, you must be registered, or licensed. Nursing applicants across Canada except residents of the province of Quebec write the Canadian Practical Nurse Registration Exam (CPNRE). Beginning in 2022, nursing applicants in Ontario and British Columbia (BC) will write the Regulatory Exam – Practical Nurse (REx-PN). The licensure exams are administered by the individual provincial or territorial regulatory authorities. To write the exam, you must have completed an accredited nursing program or have foreign qualifications that have been assessed as being equivalent to a Canadian practical nursing education. Candidates who pass the exam in their home province or territory and meet all other requirements for registration qualify to apply for registration in all other jurisdictions in Canada. Questions on the licensure exams are designed to evaluate the knowledge of generalist nurses who have just finished their education. Nursing specialties are not tested. Testable material is applicable whether in large cities with teaching hospitals or small towns with community clinics. When writing the exam, you need to be able to answer questions based on the knowledge, skills, and behaviours of any practical nurse, not just on what you or your colleagues might have experienced in a particular setting. Most questions you encounter on the exam contain only information found in textbooks or other authorized resources. CPNRE The development of the exam begins with a specific blueprint, or framework. Individual questions are authored by a team of nursing experts from across Canada. Each test item is reviewed, validated, and then piloted prior to being placed in a test bank. It takes more than a year to complete this process. Thus, most questions you encounter on the CPNRE were written several years ago and contain only information found in textbooks or other authorized resources. For each CPNRE exam, questions are randomly chosen from a test bank. Individual exams are not exactly the same, so the June exam is different from the September, November, and January exams. Others you speak with may describe past exams as having been focused, for example, on pediatric, mental health, or maternal–child nursing, but you need to remember that your exam will be different. Each exam has a different pass mark. Some versions of the exam may be considered more difficult than others. A panel of experts determines the pass mark depending on the assessed difficulty of a particular exam. Exams considered difficult will have lower pass marks than exams that are considered easier. You receive a mark for each correct response. Marks are not deducted for incorrect answers. The results of the exam are reported as Pass or Fail. If, for example, the pass mark for a particular exam version is 125 and you scored 125 or higher, you would pass. If, however, you scored lower than 125, you would fail. There is no bell curve applied to the exam results. A frequent worry of students who are about to write the exam is, “What happens if I fail?” With proper preparation, including management of “test stress,” this outcome should not occur. A candidate is allowed to write the exam a maximum of three times. Students who fail the exam may contact their regional regulatory bodies for information about having their paper regraded or about initiating an appeal. REx-PN The REx-PN is a newly developed exam based on data from a practice analysis completed in 2019, and which will be repeated every 5 years. This practice analysis was then used to develop a framework. Individual questions are authored by nursing experts in Ontario and BC. Each test item is reviewed, validated, and will be pretested by student volunteers who are preparing to graduate in 2020 and 2021 to determine the difficulty level for each item before being placed in an item bank. The REx-PN will differ from the CPNRE in that it will use computerized adaptive testing (CAT). In this format, the system will determine the level of difficulty of the question it presents to you based on how well you responded to the preceding question. For example, if you responded correctly to a question of medium difficulty, the next question presented to you will be slightly more difficult. You must achieve a certain ability level on the exam to pass. If you do not pass the REx-PN exam, you will have no limit on the number of times you can write the exam. However, you will have to wait a minimum of 60 days before writing again, up to a maximum of six attempts per year. After a fail, students will receive a breakdown of results, including areas of knowledge deficits. Students can then use this information to identify areas to focus on for further study (CNO, 2020). How to use this Book Mosby’s Prep Guide for the Canadian PN Exam is designed to provide you with practice exams that are similar in content to the CPNRE and REx-PN licensure exams. The value of the practice exams is that they give you the opportunity to apply your knowledge to the multiple-choice type of questions you will experience in the exam. You can choose to write each exam as a whole to mimic a 4-hour exam condition, or you can answer each question individually. Once you have answered the questions, review the correct answers and rationales. Were there knowledge gaps? Did you misread the question? Did you add information that was not in the question? Did you misunderstand the question? Identify the frequency with which you made particular errors, and use this information as a database for further study. Perhaps you need to review certain topics, practise your math skills, or increase your reading comprehension. Remember, you are not expected to get a perfect score. If you correctly answer about 70% of the questions, you demonstrate the potential for success on the actual licensure exam. Do not use this prep guide as a source for studying content, and do not attempt to memorize any of the information from the questions in this guide. All test items on the licensure exams are secure and have never been published, so the questions found in this book will not appear on the licensure exams. Description of the Canadian Practical Nurse Licensure Examinations—REx-PN and CPNRE REx-PN and CPNRE The Canadian Practical Nurse Exam (CPNRE) consists of 165–70 questions, including experimental questions that are not scored, in multiple-choice format. Writing time is 4 hours. Questions are written at different cognitive levels: knowledge/comprehension, application, and critical thinking. The knowledge–comprehension level requires recollection of facts. The application level of the intellectual process requires not only knowing and understanding information but also being able to apply it to a new situation. Critical thinking questions ask you to analyze, evaluate, problem-solve, or interpret data from a variety of sources before you respond to them. The REx-PN exam is a variable length computerized adaptive test and can range from 90 to 150 items, including 30 pretest items that are not scored. Question format may include multiple choice, multiple response, fill-in-the-blank calculation, exhibit, and graphics. Writing time is 4 hours. Test items are categorized by the level of difficulty, and the difficulty level of a question you receive is based on your previous answer. Entry-To-Practice Competencies The licensure exam focuses on testing entry-level competencies that are essential to providing safe care at the beginning of your practical nurse career. Competencies include knowledge, skills, behaviours, attitudes, and judgements that a practical nurse is expected to demonstrate in order to provide safe, professional care. In the licensure exam, competencies are applied to various health situations and clients. For example, what are the safety hazards for the mental health client, the infant, or the older person? How do you prevent the spread of infection in a hospital, a day care centre, or to an immunocompromised client? Practical nurses learn these competencies in their education programs. There are 79 competencies in BC and Ontario and 76 competencies in the rest of Canada. The competencies are organized in five categories. See the Appendix for a complete list of the entry-to-practice competencies. Competency Categories Professional Practice Professional practice means that the practical nurse is accountable for safe, competent, ethical nursing care. Professional practice includes professional conduct and evidence- informed practice. Sample Competency Initiates, maintains, and terminates the therapeutic nurse–client relationship. Related Sample Question What is the most therapeutic response to Mr. Smith’s question, “Am I going to die?” 1. “No, of course not.” 2. “You have a very serious illness.” 3. “Do you think you are going to die?” 4. “What have you been told about your illness and prognosis?” The correct answer is 4. This response invites Mr. Smith to discuss his understanding of his illness and provides the nurse with baseline information for further dialogue. Ethical Practice Practical nurses use ethical frameworks when making professional judgements and practice decisions. Ethical practice involves understanding the impact of personal values, beliefs, and assumptions in the provision of care. Sample Competency Establishes and maintains professional boundaries Related Sample Question Ms. Jasper, a client newly admitted to a mental health facility, asks the practical nurse, “Do you have a boyfriend?” What is the most appropriate response by the nurse? 1. “Let’s talk about you. Do you have a boyfriend?” 2. “I am not allowed to tell you about my personal life.” 3. “Yes I do. We have been together for three wonderful years.” 4. “This interview is about you, not me.” The correct answer is 4. This response refocuses the conversation to the client and does not cross professional boundaries. Legal Practice Practical nurses adhere to applicable legislation and regulations, standards, and policies that direct practice. Practical nurses have knowledge of the relevant laws and legal boundaries within which they practice. Sample Competency Documents according to established legislation, practice standards, ethics, and organizational policies. Related Sample Question Mrs. Leung was found by the nurse at 0100 hours lying on the floor beside her bed. What should the nurse document in the health record? 1. Mrs. Leung fell out of bed at 0100. 2. At 0100 hours, Mrs. Leung was found by the nurse on the floor beside her bed. 3. Mrs. Leung got out of bed at 0100 hours, slipped, and fell on the floor. 4. Mrs. Leung apparently fell out of bed at approximately 0100 hours. The correct answer is 2. This notation provides factual and objective documentation about the nurse’s observation. Foundations of Practice Foundational knowledge includes nursing theory, health sciences, humanities, pharmacology, and ethics. Sample Competency Demonstrates knowledge of nursing theory, pharmacology, health sciences, humanities, and ethics. Related Sample Question Which of the following lunch menus would be most appropriate and nutritious for a healthy 2-year-old child? 1. Hamburger and French fries 2. Jelly sandwich and grape soda 3. Cheese sandwich and fruit slices 4. Macaroni and cheese and cookies The correct answer is 3. This menu provides healthy nutrients and would appeal to a toddler. Collaborative Practice Collaborative practice involves mutual respect and effective communication when working collaboratively with clients and other members of the health care team. Sample Competency Demonstrates leadership, direction, and supervision to unregulated health workers and others. Related Sample Question The practical nurse checks on a client who was admitted to the hospital with pneumonia. He has been coughing profusely and has required nasotracheal suctioning. He has an intravenous infusion of antibiotics. He is febrile. Which of the following tasks may the practical nurse delegate to the support worker assigned to the client today? 1. Assessing vital signs 2. Changing intravenous dressing 3. Nasotracheal suctioning 4. Administering a bed bath The correct answer is 4. The practical nurse may delegate this task to the support worker. Multiple-Choice Questions The CPNRE and the REx-PN both contain multiple-choice questions. The multiple- choice questions on the CPNRE are written as either case-based or independent questions. Case-based questions present a health care situation along with approximately 3–5 questions related to the scenario. Independent, or stand-alone, items contain all the information necessary to answer the question. Each multiple-choice question is made up of two components. The part of the item that asks the question or poses a problem is called the stem. The alternatives from which you are asked to select the best answer are called the options. There are four options; only one of the options is the correct answer. The other three options are called distractors. Distractors may seem to be reasonable answers but are, in fact, incorrect or incomplete. Only one answer is correct. There are no combination options such as “1 and 2,” “all of the above,” or “none of the above.” All questions are worth one mark. Marks are not deducted for wrong answers. Sample Question While receiving a blood transfusion, Mr. Ryan develops chills and a headache. What would be the practical nurse’s initial action? 1. Notify the physician stat. 2. Stop the transfusion immediately. 3. Cover Mr. Ryan with a blanket and administer ordered acetaminophen (Tylenol). 4. Slow the blood flow to keep the vein open. The correct answer is 2. Mr. Ryan is experiencing a transfusion reaction, thus the blood infusion must be stopped immediately. The REx-PN contains many multiple-choice questions. You may also be asked questions that are multiple response, fill-in-the-blank calculation, exhibit, and graphics. See Evolve for further information. Study and Exam Tips Although you may be academically well prepared to write the licensure exam, strategies for studying, stress management, and test taking will increase your chances of success and help to alleviate anxiety. Study Tips It is easy to become overwhelmed as you prepare to study for the licensure exam. Remember, though, that you know a lot more than you think you do. While studying is crucial, much learning is not a conscious activity. The first key to developing successful study strategies is to be realistic. Identify where you have incomplete knowledge or the need to refresh your learning. Keep in mind that most of the questions on the exam do not merely test recalled facts, so you should try to understand the material that you read, rather than memorize it. The focus of your studies should be on principles of care and nursing interventions within a particular health situation, that is, what should the practical nurse do or say? One of the best strategies for learning is to form a study group. Self-testing and peer testing have proven to be the most effective methods for consolidating material. Have each member of the group choose a topic to teach the other members. This way, you stimulate discussion and get different perspectives on the subjects, which will help you in understanding and remembering them. If you are unable to participate in a study group, try teaching yourself the information. Rephrase or reword the written information to aid in understanding rather than memorizing. Repetition works well for many people. If you are having trouble remembering some knowledge material, it may help to record it so that you can play it aloud while performing other activities. Schedule your studying. Start reviewing content several months prior to the exam so that you do not feel rushed or panicked at the volume of material you need to learn. Cramming or “all-nighters” may be useful for memorizing facts, but the licensure exam is an exam that requires problem-solving based on a comprehensive knowledge base. It is better to think through and analyze the material, make judgements, and determine how the subject relates to nursing. By performing these analytical and reflective processes, you are more likely to commit the information to long-term memory, which is much more reliable than your short-term memory. To remember the strategies for studying, you can use the initialism PQRS, which stands for planning, questions practice, repetition, and self- and peer testing. While you study, remember to stay hydrated, eat sensibly, build in exercise breaks, and get plenty of sleep. It is also important to pursue other activities and not be involved solely in study. Research has shown that both sleep and “time out,” in the form of exercise, social activities, or nutrition breaks, help to consolidate learned information. Managing Stress Student Quotation “If I answer one more multiple-choice question, I think I may become physically ill. I won’t be able to help myself. Can’t they think of any other way of assessing how much we know?” The student quoted above is setting himself up for failure because of his negativity toward the format of the test. It is perfectly normal to feel nervous and anxious about the licensure exam. You have worked hard to be successful in your nursing program, and now all that effort comes down to passing one exam. As you prepare for the exam, empower yourself by developing a positive mental attitude. Henry Ford said, “Whether you think you can or think you can’t… you’re right.” Challenge your negative thoughts! Do not let them guide you. Tips Become active and positive about your learning and your preparation. The more actively you plan and prepare, the more likely you will be successful. The following tips will help you manage stress: Try to avoid fellow students who feel overly anxious about the exam. Anxiety is like a communicable disease. You can catch it. Use the power of positive thinking. Build up your self-confidence by repeating to yourself, “I am well prepared. I will pass this exam.” Practise yoga or other forms of exercise; they are great stress relievers. Try aromatherapy—lavender works well to promote relaxation. Sometimes just the smell will help you remember to relax and breathe. Eat a well-balanced diet, and get plenty of rest. The Evening Before The Exam Student Quotation “The night before a test, I can’t sleep. Then I worry because I can’t sleep. Then I can’t sleep because I’m worrying that I’m worried that I can’t sleep. By morning, I’m glad to get out of bed just to stop the terrible racket in my head.” The evening before the exam, organize your clothes and exam supplies (e.g., identification, bottle of water). Make sure you know the location of the exam and have arranged your transport to the exam. Then be nice to yourself. Do something you enjoy and get a good night’s sleep. Information is processed during sleep, so sleep will help you retain what you have studied. Last-minute cramming may have aided you in past test situations but is helpful only for memorizing facts. It actually decreases your ability to problem-solve the application and critical-thinking types of questions that are on the licensure exam. The Day of The Exam Eat a healthy breakfast of protein and carbohydrates. Engage in moderate exercise if possible. If you absolutely cannot eat, try drinking a sports electrolyte solution. Although you need to be adequately hydrated, do not drink too many fluids or cups of coffee. Dress in comfortable clothes, preferably in layers, so that you can add or take off articles depending on the temperature of the exam room. Plan to arrive at the test location at least 30 minutes ahead of the exam start time. This cushion will allow you time to relax, visit with friends, and prepare yourself mentally. However, avoid talking about the exam with your friends as conversations about it will only make you more anxious. Arriving early also gives you time for that last-minute washroom trip—stress is a potent diuretic. When you sit down in the exam room, make a conscious effort to relax and continue your positive thinking. After The Exam After the exam, you will likely feel a sense of relief that it is over, but you may also feel the need to review questions in your head and discuss answers with your peers. Try not to dwell on this activity for too long. These postmortems can bring you down. Remember, you have probably done better than you think! Content to Study Mosby’s Comprehensive Review for the Canadian PN Exam is the most valuable resource for your licensure exam studying. This uniquely Canadian-based review text has content created specifically for Canadian practical nurses, providing all you need to know about practical nursing in Canada—and to pass the licensure exam—in one text. Your first step in preparing for the exam is to review the Competencies in the Appendix. Notice the wording: advocates, collaborates, supports, takes action, engages, facilitates, promotes, and integrates. Professional Practice The topics of the Professional Practice competencies include accountability, scope of practice, self-awareness, adherence to regulatory requirements, competence, therapeutic nurse–client relationship, nonjudgemental care, sensitivity to spiritual beliefs and cultural practices, supporting clients in making informed decisions, self-reflection and continuous learning, integration of relevant evidence, role in practice and policy, continuous quality improvement, professionalism, fitness to practice, maintaining current knowledge of relevant trends and issues, professional misconduct, action with near misses, errors and adverse events, and distinguishing mandates of regulatory bodies, professional associations and unions. Other resources for this competency include provincial standards of practice and related websites; Potter et al., Canadian Fundamentals of Nursing, sixth edition; and Arnold and Boggs, Interpersonal Relationships, eighth edition. Ethical Practice The topics of the Ethical Practice competencies include professional boundaries, personal values, respect for clients, ethics, truth and reconciliation, dignity, sensitivity to diversity, and advocacy. Adherence to the duty to provide care is a competency in ON and BC only. Other resources for this competency include provincial standards of practice and related websites; Potter et al., Canadian Fundamentals of Nursing, sixth edition; and Keatings and Adams, Ethical and Legal Issues in Canadian Nursing, fourth edition. Legal Practice The topics of the Legal Practice competencies include adherence to legislation and regulations, promoting safe practice, adherence to duty to report, confidentiality and privacy, documentation, and informed consent. Other resources for this competency include Potter et al., Canadian Fundamentals of Nursing, sixth edition and Keatings and Adams, Ethical and Legal Issues in Canadian Nursing, fourth edition. Foundations of Practice The topics of the Foundations of Practice competencies include comprehensive health assessment; technology application; research and response to relevant clinical data; evidence-informed practice; comprehension, response to, and report of assessment findings, formulation of clinical decisions, identification of nursing diagnosis, care plans; appropriate interventions; intervention prioritization; health literacy; teaching and learning; health education; client safety; quality improvement and risk management; evaluation of nursing interventions; care plan revision and appropriate communication; assessment of implications of own decisions; critical thinking, critical inquiry and clinical judgement; professional judgement in utilization of technology and social media; safe care; prevention, de-escalation and management of disruptive, aggressive, violent behaviour; recognition and response to client’s deteriorating condition; and knowledge of nursing theory, pharmacology, health sciences, humanities, and ethics. ON and BC have an additional competency: application of knowledge of pharmacology and principles of safe medication practice. Other resources for this competency include Potter et al., Canadian Fundamentals of Nursing, sixth edition and Jarvis et al., Physical Examination and Health Assessment, third Canadian edition. Collaborative Practice The topics of the Collaborative Practice competencies include client engagement; collaborative communication; providing essential client information; promoting effective interpersonal interaction; conflict resolution; role articulation; role determination; advocating for use of Indigenous health knowledge in collaboration with the client; leadership, direction and supervision of unregulated health workers; emergency preparedness and disaster management; quality practice environment; encouraging questioning and exchange of information; mentoring; group process; leadership; and time management. Additionally, ON and BC have the competency: preparing client and collaborating with health care team in transitions and transfer of responsibility of care. Other resources for this competency include provincial standards of practice and related websites; Potter et al., Canadian Fundamentals of Nursing, sixth edition; Arnold and Boggs, Interpersonal Relationships, eighth edition; and Wadell and Walton, Yoder- Wise’s Leading and Managing in Canadian Nursing, second edition. Although the licensure exam is based on competencies, most resources you will be using for study are organized by topic or clinical area. The following sections outline the most common subjects within these traditional topic areas. Mosby’s Comprehensive Review for the Canadian PN Exam contains all the necessary information in each section. However, should you choose to conduct further research, alternative resources are provided. When reviewing specific conditions and diseases, focus on the related nursing implications and remember to think about community-based aspects of care. Medical–Surgical Nursing You cannot know all diseases. Try to think globally and consider all problems associated with a system, rather than studying specific diseases. Remember that it is unlikely that you will be asked to recall specifics of disease pathology. Rather, you will need to understand effective therapies, including associated clinical skills and interventions. Endocrine: diabetes Type 1 and 2 Cardiovascular: stroke, myocardial infarction, heart failure, peripheral vascular disease Hematology: anemia, leukemias Gastrointestinal: Crohn’s, colitis, diverticulitis, colorectal cancer, constipation, diarrhea, ulcers, appendicitis Renal: urinary tract infections, renal failure, dialysis, incontinence Liver: cirrhosis, hepatitis, pancreatitis Respiratory: chronic obstructive pulmonary disease (COPD), asthma, pneumonia, lung cancer, tuberculosis, common cold, atelectasis, pneumothorax/hemothorax Musculoskeletal: arthritis, osteoporosis, fractures, chronic fatigue syndrome, scoliosis, multiple sclerosis Immune: human immunodeficiency virus (HIV), inflammation Infections: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin- resistant enterococci (VRE), Clostridium difficile (C. diff.), influenza, common cold, sepsis, epidemics, pandemics Sensory: cataracts, glaucoma, hearing loss Integumentary: burns, infestations, allergies Neurological: seizures, intracranial pressure, Parkinson’s, multiple sclerosis, spinal cord injuries Women’s and men’s health: menopause, birth control, sexually transmitted infections, breast and prostate cancers Emergency: shock, hemorrhage, anaphylaxis Fluid and electrolyte, acid–base imbalance Resources include Lewis et al., Medical-Surgical Nursing in Canada, fourth Canadian edition, and www.sexandu.ca. Maternal–Child Nursing Health in child-bearing years Fertility Prenatal care Fetal development Pregnancy risks and complications Labour and birth Apgar scoring Newborn assessment Preterm and newborn health problems Postpartum care Breastfeeding Bonding Resources include Perry et al., Maternal Child Nursing Care in Canada, second edition and Leifer and Keenan-Lindsay, Leifer’s Introduction to Maternity and Pediatric Nursing in Canada. Pediatric Nursing Family and parenting; child development, infancy to adolescence; play; safety Respiratory: asthma, respiratory syncytial virus (RSV), croup, cystic fibrosis Gastrointestinal: gastroenteritis, reflux, cleft lip and palate, appendicitis, pyloric stenosis Cardiovascular: atrial septal defect (ASD), ventricular septal defect (VSD) Hematology: sickle cell, leukemias, anemia Immune: human immunodeficiency virus (HIV) Infections and immunization: common childhood infectious diseases, schedule of vaccines Genitourinary: urinary tract infections Neurological: head injury, seizures, meningitis, hydrocephalus Endocrine: diabetes Integumentary: infestations, allergies Musculoskeletal: trauma, fractures, sprains and strains, arthritis, scoliosis Neuromuscular: cerebral palsy Resources include Hockenberry et al., Wong’s Essentials of Pediatric Nursing, eleventh edition and Leifer and Keenan-Lindsay, Leifer’s Introduction to Maternity and Pediatric Nursing in Canada. Mental Health Nursing Legal, ethical, interpersonal, communication, and therapeutic approaches Mood disorders: depression, bipolar Anxiety disorders: phobias, obsessive compulsive disorder Schizophrenia spectrum and other psychotic disorders Personality disorders Substance-related and addictive disorders Cognitive disorders: dementias, Alzheimer’s Sexual and identity disorders Eating disorders, body dysmorphic disorder Psychiatric emergencies Resources include Halter, Varcarolis’ Foundations of Psychiatric Mental Health Nursing, eighth edition. Diagnostic Tests Understand the reason for the test and the appropriate health teaching for the client. Biopsies X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasounds, nuclear scans Mammograms Gastrointestinal scopes, bronchoscopes Allergy tests Oxygen saturation, pulmonary function tests Fetal tests Resources include Pagana et al., Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, second edition. Laboratory Tests Note the normal ranges and test implications. Complete blood count (CBC) International normalized ratio (INR) Blood glucose Blood urea nitrogen (BUN) Creatinine Glycosylated hemoglobin (HbA1c) Glomerular filtration rate (GFR) Electrolytes Cholesterol Urinalysis Culture and sensitivity (C & S) Stool Low-density lipoprotein (LDL), high-density lipoprotein (HDL) Resources include Pagana et al., Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, second edition. Pharmacology Note classifications, common drugs within each classification, therapeutic effects, and precautions. You will need to know about frequently prescribed and over-the-counter drugs. Knowledge regarding common herbal preparations may also be tested. Keep in mind lifespan considerations. Analgesics and anti-inflammatories: narcotic and non-narcotic (e.g., Tylenol, nonsteroidal anti-inflammatory drugs [NSAIDs], morphine, and Demerol) Antacids Antidepressants (e.g., selective serotonin reuptake inhibitors [SSRIs]) Antibiotics (e.g., penicillin, ampicillin) Anticoagulants (e.g., Coumadin, heparin) Antidiabetics (e.g., insulin, oral hypoglycemics) Antivirals Cardiac drugs (e.g., nitroglycerin, digoxin, antihypertensives) Corticosteroids (e.g., prednisone) Diuretics (e.g., furosemide [Lasix]) Hormones Respiratory drugs (e.g., bronchodilators, inhaled steroids) Stool softeners and laxatives (e.g., psyllium [Metamucil], docusate sodium [Colace]) Statins (e.g., atorvastatin [Lipitor]) Vitamins and minerals Alternative, complementary, or herbal preparations Resources include Sealock, Lilley’s Pharmacology for Canadian Health Care Practice, fourth Canadian edition; Skidmore-Roth, Mosby’s Nursing Drug Reference, thirty-fourth edition. Clinical Skills To test your clinical skills, the exam may include questions about any or all of the following: vital signs, infection control, medication administration, body mechanics, hygiene, positioning, suctioning, chest tubes, oxygen therapy, tracheostomy, intravenous initiating and maintaining, urine specimens, urinary catheters, enemas, wound care, ostomies, and first aid. Resources include Potter et al., Canadian Fundamentals of Nursing, sixth edition, and Perry et al., Canadian Clinical Nursing Skills and Techniques. Tips for Writing Multiple-Choice Exams Listed below are some tips for completing the multiple-choice questions particular to the licensure exam: A. Read and listen to the instructions carefully. B. Plan your time and pace yourself. Keep track of time. You should answer approximately 25 to 30 questions in each half-hour. C. Reading comprehension is crucial to success. Read the stem of each question carefully and make sure that you understand exactly what it asks. One of the most common test-taking errors is misreading the question. Identify words such as initial or most important or priority. Take special note of any negatives such as never or except. Sam ple Que stion Ms. Chang’s surgical dressing is saturated in blood. What would be an early sign of hemorrhagic shock? 1. Increased blood pressure 2. Pallor 3. Increased pulse 4. Shallow breathing The key word is early; thus the correct answer is 3. D. Be prepared to problem-solve every question. E. Try to answer the question before looking at the multiple-choice options. F. Read all the options before choosing one. Do not immediately assume a response is correct without looking at all the other options; another answer may be more correct than the one you choose first. G. Read each option carefully, mentally crossing out the options you know are incorrect. Choose the best option out of the ones remaining. H. Some questions that appear to be trick questions may, in reality, measure your ability to think critically. If you believe all the options are correct, choose the one that is most comprehensive, makes the most common sense, or is the most professional answer. Sam ple Que stion Which of the following is most important when performing a preoperative assessment? 1. Physical assessment 2. Cardiac assessment 3. Assessment of vital signs 4. Auscultation of breath sounds All options are valid, but answer 1 is the most inclusive. I. To choose the most important nursing action when all of the answers appear to be correct, take the following steps: Read the situation and question very carefully. In almost all cases, consider the mnemonic ABC (airway, breathing, circulation), with airway being the most important. Remember the “nursing process”: collecting and validating information before acting. Consider safety—for the client and for yourself. Choose an action that can be completed quickly and safely, almost at the same time as other actions. Do not necessarily look for fancy answers. Choose simple, common-sense, safe actions. Choose the sickest, most unstable client as the priority. J. A common error students make is choosing a response that might have been applicable in a specific client situation that they have experienced. Always answer according to “textbook,” or standard, nursing principles. K. Answer as you believe the perfect “textbook practical nurse” would answer. L. Do not assume any information that is not given. Choose your answer based only on information in the question asked. M. Do not panic if you have never heard of a particular disease or client situation. Apply general nursing principles to each question—the particular client health state may not matter. Candidates for the exam come from various academic backgrounds, and curricula are not identical in all education institutions. You are not expected to know all the answers, nor are you expected to write a perfect exam! Sam ple Que stion Ms. Townsend is suffering from Hick’s asymmetrical dementia. Which of the following activities would be appropriate for her condition? 1. Vigorous exercise 2. Competitive games 3. Social stimulation in group activities 4. Solitary reading Hick’s asymmetrical dementia is a fictitious disorder. The care needs for a client with dementia are fundamental, so the correct response is answer 3. This is a “trick question” for the purpose of illustration. The licensure exam, however, contains no trick questions. N. Your first answer choice is usually correct. You may have learned some information subconsciously, and your first impression is often an automatic response to what you have learned. Do not second-guess yourself unless you are absolutely sure that you have misunderstood the question or provided a wrong answer. O. Select answers that are therapeutic, show respect, involve the client in care, and focus on nursing judgement rather than hospital rules or orders from other health team members. Sam ple Que stion Jessica tells the practical nurse, “I am tired of waiting for you to brush my hair. You’re never here when I want you.” Which of the following responses is the most appropriate for the practical nurse to give? 1. “I’m sorry you’ve had to wait. I’ll get your hairbrush out for you and be back in 15 minutes to do your hair.” 2. “That’s not fair. I spent my lunch break with you yesterday.” 3. “Jeremy down the hall is really sick, and he needs me more than you do right now.” 4. “I’m doing my best, but I have a really busy assignment today.” Option 1 acknowledges the client’s feelings, shows respect, and provides a clear, factual response. Sam ple Que stion Ms. Steele asks the practical nurse when she can start eating after surgery. What is the most appropriate response for the practical nurse to give? 1. “You’ll have to ask the doctor.” 2. “Tell me about your appetite.” 3. “You’ll likely start on clear fluids once bowel sounds can be heard.” 4. “I’ll have the dietitian consult with you about the most nutritious postsurgery menus.” Option 3 involves nursing judgement and directly answers the client’s question. P. Most questions will ask about actions that are based on nursing judgement rather than physician orders. However, some questions may test your knowledge of the scope of nursing practice and have as a correct response “contact the doctor.” Examples of such situations include unclear or illegible orders, a specific request from a client, deteriorating client condition, and a client emergency. Q. In the case of communication questions, answers that demonstrate the practical nurse asking the client open-ended questions are most often correct. Sam ple Que stion Which of the following would elicit the best information from Mr. Loates about his pain? 1. “Do you have severe pain?” 2. “Do you have any pain?” 3. “Is your pain throbbing or stabbing?” 4. “Describe your pain to me.” Option 4 is open-ended—that is, it requires the client to give more than a one- or two-word answer. Phrasing questions in an open-ended fashion is a key component of therapeutic nursing communication. R. Do not choose an answer because you have seen that question before and think you recall the answer. Questions on the exam may look similar to ones you have encountered during practice but will not be exactly the same. Therefore, the answer may also not be the same. S. There is no pattern to the assigned answers. Do not change an answer because you have had too many answers in the same position. T. If all else fails, guess. Never leave a question unanswered. You have at least a 25% chance of getting it correct. Tips f or Gue ssing 1. If two of the options are similar except for one or two words, choose one of those. Example Take the apical pulse Take the radial pulse 2. If two options have opposite meanings, choose one of those. Example Vasodilation Vasoconstriction 3. If two quantities or mathematical calculations are similar, choose one of those. Example 0.14 mL 0.014 mL 4. Choose the longest answer. 5. While there is no pattern to the answers, some studies say that in multiple-choice exams, option b or 2 is correct most of the time. U. Answering many questions can be boring and tiring. You may find yourself becoming confused about what information relates to the question. Throughout the exam, take a mini-exercise break every 20 minutes; sip water, do neck rolls, and flex your arms and legs. V. Do not panic if someone leaves when you have completed only 20 questions. The time taken to complete the exam is not an indication of performance on the exam. Computer Adaptive Testing The REx-PN uses a computer adaptive testing format. “Examination items are presented to the candidate one at a time on a computer screen. There is no time limit for a candidate to spend on each individual item. Once an answer to an item is selected, the candidate has the ability to consider the answer and change it, if necessary. However, once the candidate confirms the answer and proceeds to the next time by pressing the button, the candidate will no longer have the ability to return to a previous item. The computer will not allow the candidate to proceed to the next item without answering the current item on the screen. The best advice is to maintain a reasonable pace (one item every minute or two), and carefully read and consider each item before answering. During the administration of the REx-PN, candidates will be required to respond to items in a variety of formats. These formats may include multiple-choice, multiple response, fill-in-the-blank calculation, exhibit, and graphics.” (National Council of State Boards of Nursing. (2020). 2022 REx-PN Test Plan). Summary Preparing for the exam well in advance, ensuring comprehensive content review, following the exam-taking tips, developing your reading comprehension, and maintaining a positive outlook will equip you with the necessary abilities to be successful in the licensure exam. Practice Exam 1 Introduction to Practice Exams The practice exam questions are designed to be similar to those you will encounter in the licensure exam. Instructions for Practice Exam 1 You will have 4 hours to complete the exam. The questions are presented as nursing cases or as independent questions. Read each question carefully, and then choose the answer that you think is the best of the four options presented. If you cannot decide on an answer to a question, proceed to the next question and return to this question later if you have time. Try to answer all the questions. Marks are not subtracted for wrong answers. If you are unsure of an answer, it will be to your advantage to guess. Answers to Practice Exam 1 appear on page 44. Case-Based Questions Case 1 A practical nurse works in a medical–surgical unit of a hospital administering medication to her clients. Medications are dispensed through automated dispensing system. QUESTIONS 1 to 6 refer to this case. 1. What is the most accurate method for the practical nurse to determine she is administering the correct medication to Mr. Rickhelm? 1. Compare the name of the drug on the medication prepackage with the prescriber’s order. 2. Ask Mr. Rickhelm to confirm he is receiving the correct medication. 3. Contact the agency pharmacy to confirm Mr. Rickhelm’s medication profile. 4. Check the medication identified on the medication prepackage against information from a drug reference text or agency intranet site. 2. Mr. Ogalino has been taking a brand name oral anti-infective medication at home for 6 months prior to being admitted to hospital. When the practical nurse brings his medications to him for the first time, he states, “What is this pink pill? I have never taken that one before.” Which of the following responses by the practical nurse indicates safe medication administration? 1. “This is a generic form of your regular anti-infective.” 2. “I don’t know, but I’ll check your medication record.” 3. “This is what your doctor has prescribed for you.” 4. “If you wish, you may refuse the medication.” 3. Ms. Jasmin is a newly admitted client to the unit. The practical nurse prepares to administer long-acting insulin to her at 1800 hours. Ms. Jasmin tells the practical nurse that at home she takes this insulin at bedtime, around 2300 hours. How should the practical nurse respond? 1. “I will test your blood sugar to make sure this is the best time to inject your insulin.” 2. “What is the reason you take your insulin at bedtime?” 3. “Generally the schedule for administering insulin is different when you are in hospital than when you are at home.” 4. “Bedtime is not the best time for administration of long-acting insulin.” 4. Ms. Corel is admitted to the unit with a diagnosis of deep vein thrombosis. Which of the following categories of drugs is likely to be ordered? 1. A statin 2. An antibiotic 3. An analgesic 4. An anticoagulant 5. The pharmacy technician comes to the unit to add some narcotics to the narcotic draw on the unit. The pharmacy technician asks the practical nurse to sign as a witness for the added medications to the narcotic draw count. Who may legally sign the narcotics administration count sheet? 1. A registered nurse (RN) 2. An RN or registered/licensed practical nurse (RPN/LPN) 3. An RN or a physician 4. Any registered or regulated health care provider 6. Mrs. Aina is ordered digoxin (Lanoxin) 0.075 mg. The pharmacy dispenses digoxin, three tablets of 0.25 mg for the above order. The practical nurse administers the provided three tablets of digoxin. Evaluate this action. 1. Correct, as the digoxin has been calculated by the pharmacy. 2. Correct, as the digoxin is the same dose that the physician has ordered. 3. Incorrect, as the ordered dose of digoxin is below the therapeutic level. 4. Incorrect, as the dose administered is too high. END OF CASE 1 Case 2 Mr. Smadu, age 19 years, was diagnosed with a schizophrenia disorder 8 months ago. His symptoms include hallucinations, delusions, flat affect, and grossly disorganized behaviour. He lives at home with his mother and his sister Shannon, both of whom work full time. His father and extended family live in another country and are not involved in his care. His mother has asked for a visit from the community nurse to discuss concerns she has regarding her son’s management at home. The practical nurse visits with Mr. Smadu, his mother, and his sister. QUESTIONS 7 to 13 refer to this case. 7. Mr. Smadu’s mother and sister ask the practical nurse what the best way is to respond when he is hearing voices. What should the practical nurse advise them to say? 1. “I do not hear the voices that you hear.” 2. “Who is talking to you?” 3. “There are no voices talking to you.” 4. “Why do you say you are hearing voices?” 8. Mr. Smadu asks for suggestions to help him cope with the voices he hears. What might the practical nurse suggest? 1. To tell the voices to go away 2. To listen to music on his headphones 3. To distract himself by going for a walk 4. To increase his dose of antipsychotic medication 9. Mr. Smadu’s mother tells the practical nurse some of the neighbours are concerned that her son will be violent. They are afraid of him when he yells at the voices. What should the practical nurse advise Mr. Smadu’s mother to tell the neighbours? 1. “My son has a disease that causes him to hear voices, but he will never be violent.” 2. “Call the police if my son is acting in a strange manner.” 3. “Engage my son in conversation to distract him.” 4. “Do not crowd my son or get too close to him if he appears agitated.” 10. Mr. Smadu is being treated with risperidone (Risperdal) 40 mg intramuscularly (IM) every 2 weeks to help manage his psychotic behaviours. What is the primary reason this drug is given to him by the intramuscular rather than oral route? 1. It is not absorbed from the gastrointestinal tract. 2. There is better compliance when given every 2 weeks by injection. 3. There is greater therapeutic response with the IM route. 4. The IM route decreases the incidence of tardive dyskinesia. 11. Mr. Smadu’s mother asks if her son will ever get better. What is the practical nurse’s best response to this question? 1. “While there is no cure for a schizophrenia disorder, people can and do improve. The exact course and impact of a schizophrenia disorder is unique to each person.” 2. “One half of people diagnosed with a schizophrenia disorder recover completely ten years from their first episode.” 3. “A schizophrenia disorder is a lifelong illness that can be managed, but he will never get better.” 4. “If he doesn’t get better, there are community supports to help you with his care.” 12. Mr. Smadu’s mother and sister tell the practical nurse that Mr. Smadu seems to have no interest in the world, has not followed through on his plan to return to school, and is generally not motivated to do anything. The practical nurse recognizes these behaviours as typical of people with a schizophrenia disorder. What is the term for these behaviours? 1. Alogia 2. Anhedonia 3. Avolition 4. Attention impairment 13. Several days after the practical nurse’s home visit, Mr. Smadu’s sister calls her because Mr. Smadu is saying that the voices are telling him to buy a gun and kill himself. How should the practical nurse advise Mr. Smadu’s sister? 1. “Find out why he wants to commit suicide.” 2. “Call 9-1-1.” 3. “Take him to the mental health clinic or the hospital.” 4. “I understand your concern, but although many people with schizophrenia say they are going to commit suicide, they almost never follow through.” END OF CASE 2 Case 3 A practical nurse works at a large teaching hospital. The hospital has recently had an outbreak of methicillin-resistant Staphylococcus aureus (MRSA). QUESTIONS 14 to 16 refer to this case. 14. The practical nurse is concerned about the spread of MRSA. Which of the following examples would be a likely mode of transmission? 1. Direct contact of an open wound with contaminated hands 2. Inhalation of aerosol particles from a person with MRSA pneumonia 3. Ingestion of contaminated food 4. Contact with blood or body fluids from a person with poor hygiene 15. Which of the following hospitalized clients has the greatest risk for acquiring MRSA? 1. Mrs. Andrews, age 65 years: pacemaker insertion 2. Andria, age 4 months: investigation of vomiting and failure to thrive 3. Mr. Anneke, age 87 years: diagnosis and assessment of possible dementia 4. Ms. Gary, age 35 years: chronic urinary tract infections secondary to spinal cord injury 16. The practical nurse has an open cut on his finger and is concerned about becoming infected with MRSA from his clients. What should the practical nurse do? 1. Keep the cut clean and cover with an occlusive adhesive bandage or tape 2. Refrain from caring for any clients with MRSA 3. Cover the cut with occlusive tape and wear gloves when performing care 4. Wash his hands before and after client contact END OF CASE 3 Case 4 Denika, age 2 years, is admitted to a hospital paediatric unit. She has a severe case of eczema, which has resulted in many infected lesions. She will be receiving intravenous (IV) antibiotics. QUESTIONS 17 to 21 refer to this case. 17. Denika has scratched her eczema to the point that she is bleeding. The practical nurse has repeatedly told her to stop, but she continues to scratch. The practical nurse decides to restrain her arms to the sides of the crib. Which explanation best describes the practical nurse’s action? 1. She has acted with professional accountability. 2. She has used actions that can be interpreted as assault and battery. 3. Denika’s skin had to be protected, so the practical nurse acted in a prudent manner. 4. The practical nurse should have asked Denika’s parents for permission to restrain her. 18. Denika visits the hospital playroom. At her age, which of the following behaviours will she likely display? 1. Building houses with blocks 2. Being possessive of toys 3. Attempting to stay within the lines when colouring 4. Amusing herself with a picture book for 15 minutes 19. Denika is to receive 1 L of IV fluid per 24 hours. Using a minidrip IV set, with a drop rate of 60 drops/mL, at what rate should the IV infuse? 1. 16 drops per minute 2. 26 drops per minute 3. 42 drops per minute 4. 48 drops per minute 20. Denika is about to be discharged. The practical nurse advises Denika’s mother to increase her fluids for several days. Her mother says Denika consistently says “no” every time she is offered fluids. What might the practical nurse advise Denika’s mother to do? 1. “Distract her with some food.” 2. “Be firm and hand her the glass.” 3. “Offer her a choice of two things to drink.” 4. “Explain to Denika why she needs to drink a lot of fluids.” 21. Denika’s mother asks the practical nurse when it would be appropriate to take her to the dentist for dental prophylaxis. What is the practical nurse’s most appropriate response? 1. Before starting primary school 2. Between 2 and 3 years of age 3. When Denika begins to lose deciduous teeth 4. The next time another family member goes to the dentist END OF CASE 4 Case 5 A practical nurse is working on a postpartum unit at the hospital. One of her clients, Ms. Oliver, just delivered a healthy baby. QUESTIONS 22 to 27 refer to this case. 22. Four hours after a vaginal delivery, Ms. Oliver still has not voided. What should be the practical nurse’s initial action? 1. Palpate her suprapubic area to check for distention 2. Encourage voiding by placing her on a bedpan frequently 3. Place her hands in warm water to encourage micturition 4. Inform the physician of her inability to void 23. Why will the practical nurse encourage Ms. Oliver to ambulate shortly after delivery? 1. It promotes respiration. 2. It increases the tone of the bladder. 3. It maintains abdominal muscle tone. 4. It increases peripheral vasomotor activity. 24. Ms. Oliver is breastfeeding her newborn. What are the expected characteristics of the infant’s stool for the first 24 hours? 1. Pale yellow to light brown, firm in consistency with a mild offensive odour 2. Mustardy yellow, soft and seedy in appearance 3. Blackish-green tarry stool 4. Brown with pebble like consistency 25. Ms. Oliver states her breasts feel engorged between feedings. What action would the practical nurse encourage Ms. Oliver to do to help relieve her engorged breast? 1. Only breast feed every 4 hours 2. Gently massage the breast from chest wall to nipple area 3. Apply warm compresses frequently 4. Restrict fluid intake 26. While checking Ms. Oliver on the second postpartum day, the practical nurse observes that Ms. Oliver’s fundus is at the umbilicus and displaced to the right. What is the likely cause of this finding? 1. A slow rate of uterine involution 2. A full, over-distended bladder 3. Retained placental fragments in the uterus 4. Overstretched uterine ligaments 27. The practical nurse observes Ms. Oliver’s lochia. What type of lochia is expected on the second postpartum day? 1. Lochia serosa 2. Lochia rubra with large clots 3. Lochia alba 4. Lochia rubra END OF CASE 5 Case 6 Mr. Richard, age 21 years, is brought to the emergency department by the police. He has been involved in a house fire caused by his mixing volatile chemicals to make illegal street drugs. Mr. Richard has a history of intravenous drug use. He has sustained burns to his face and body. He is uncoordinated in his movements and verbally combative. QUESTIONS 28 to 31 refer to this case. 28. Mr. Richard is shouting and agitated and demands to see the doctor immediately. What is the most appropriate practical nursing intervention? 1. Talk with him to de-escalate the behaviour 2. Monitor his behaviour to see if he becomes more agitated 3. Inform him that he will be asked to leave if he does not behave 4. Offer to take him to a quiet examination room where you would continue to monitor him closely 29. Mr. Richard is admitted to a medical unit. Which of the following observations by the practical nurse is a priority during the first 24 hours? 1. Wound sepsis 2. Pulmonary distress 3. Pain 4. Fluid and electrolyte imbalances 30. Mr. Richard requires an analgesic for the pain from his burns. What is the most important reason for the practical nurse to administer the drugs via the IV route rather than via IM injection? 1. IM injections increase the risk for tissue irritation. 2. IM injections are more painful than IV administration. 3. IV administration will ensure more effective absorption. 4. IV administration provides more prolonged relief of pain. 31. Mr. Richard has been charged by the police for his illegal drug possession and manufacturing. A lawyer comes to visit Mr. Richard and tells the practical nurse that he would like to read Mr. Richard’s health record. What is the most appropriate response by the practical nurse? 1. “You may read the chart if you get permission from Mr. Richard.” 2. “You will have to get permission from the doctor.” 3. “You are allowed to read the health record because Mr. Richard has been charged with a criminal offence.” 4. “I am not allowed to let you read Mr. Richard’s health record.” END OF CASE 6 Case 7 Mr. Wilmot, age 23 years, has been diagnosed with cancer in his left testicle. He is admitted to hospital for the surgical removal of the testicle. Mr. Wilmot is engaged to be married in 6 months. QUESTIONS 32 to 35 refer to this case. 32. Mr. Wilmot asks the practical nurse if he will still be able to father children after having his testicle removed. Which of the following responses by the practical nurse would be most therapeutic? 1. “The important thing is that you become healthy again. You can always adopt if children are important to you.” 2. “I understand your fears. Any intervention for cancer is likely to cause infertility.” 3. “I can see you are very concerned about this. Although you will still have one functioning testicle, perhaps you would like to discuss sperm banking before the surgery.” 4. “There is a possibility that the surgery will make you unable to maintain an erection, which would lead to an inability to father children.” 33. Mr. Wilmot tells the practical nurse that he feels he will not be a “real man” after the surgery, and he worries about losing his ability to perform sexually. How should the practical nurse respond to these concerns? 1. Tell Mr. Wilmot that he is still a man even with one testicle. 2. Reassure Mr. Wilmot there is very little chance that he will have any problems. 3. Ask Mr. Wilmot if he would like to talk with a therapist to discuss his concerns. 4. Tell Mr. Wilmot the prognosis for this type of cancer is excellent and he need not worry. 34. Which of the following topics would the practical nurse include in his client teaching? 1. Once surgery and chemotherapy are completed, Mr. Wilmot can expect to lead a normal life, free of cancer. 2. Mr. Wilmot will have to take low-dose testosterone for the rest of his life. 3. Mr. Wilmot must have regular physical exams with his oncologist. 4. The likelihood of a relapse is quite high, so Mr. Wilmot must be tested every 3 months. 35. Mr. Wilmot is ready for discharge. The practical nurse teaches self-examination of the remaining testicle. Which of the following statements is correct? 1. Once a month in the shower, roll the testis between the thumb and first three fingers to cover the entire surface. 2. Lie flat on a bed and use circular motions with the fingers to detect any unusual lumps. 3. Shine a flashlight through the testis from the side to highlight any lesions. 4. The testis will feel like a soft-boiled egg, with the epididymis feeling smoother than the testis. END OF CASE 7 Case 8 A practical nurse is in charge on the evening shift at a long-term care facility. She is the only registered practical nurse working with unregulated care providers (UCPs) who have been trained to perform basic hygiene care and take vital signs. The practical nurse is responsible for administering medications to the 20 clients on her unit. QUESTIONS 36 to 39 refer to this case. 36. Mr. Lok has a history of hypertension, treated with a variety of antihypertensive medications. The physician’s order directs the practical nurse not to administer the regularly scheduled nifedipine (Adalat) if Mr. Lok’s blood pressure is below 100 systolic. The UCP records a blood pressure of 94/72 for Mr. Lok. What should the practical nurse do? 1. Hold the nifedipine. 2. Check with the doctor before holding the nifedipine. 3. Ask the UCP if the blood pressure reading was accurate. 4. Check Mr. Lok’s blood pressure before holding the nifedipine medication. 37. Enteric-coated Aspirin (ECASA) q6hr prn is ordered for Ms. Bystriska. Which of the following is a correct nursing action related to the administration of the ECASA? 1. Obtain verbal consent from Ms. Bystriska at the time of administration of the ECASA. 2. Crush the tablet if she is unable to swallow it. 3. Leave the ECASA at her bedside for her to take as necessary. 4. Obtain a written consent that covers all medication administration. 38. Mr. Gileppo is to receive insulin subcutaneously. Which would be an incorrect action by the practical nurse when administering the insulin? 1. Injecting it into subcutaneous abdominal tissue 2. Using a 29-gauge needle 3. Massaging the area to increase absorption 4. Pinching the tissue of the lateral aspect of the thigh 39. Ms. Banwait, a client with dementia related to Alzheimer’s disease, is ordered donepezil (Aricept) to slow the progress of her disease. When the practical nurse offers her the donepezil, Ms. Banwait refuses to take it, stating that it upsets her stomach too much. Her husband, Mr. Banwait, insists that she take the medication. What should the practical nurse do? 1. Give the medication, as Ms. Banwait has dementia. 2. Give the medication, as Mr. Banwait is the next of kin and is authorized to make treatment decisions. 3. Do not give the medication, as it is producing adverse effects. 4. Do not give the medication, as Ms. Banwait has withdrawn her consent. END OF CASE 8 Case 9 A practical nurse works in a family planning clinic. She provides teaching about reproductive and sexual health and birth control to a variety of clients. QUESTIONS 40 to 44 refer to this case. 40. Ms. Eigo, age 27 years, consults the practical nurse regarding family planning. Ms. Eigo asks the practical nurse about the contraceptive diaphragm as a form of birth control. What should the practical nurse tell Ms. Eigo about the contraceptive diaphragm? 1. Use a vaginal lubricant to assist with the insertion of the diaphragm. 2. Leave the diaphragm in place once inserted as it does not require removal after each use. 3. Receive an annual gynecologic examination to assess the fit of the diaphragm. 4. Do not use a spermicide with this form of contraception. 41. Sarah, a 16-year-old single adolescent, finds out that she is 4 weeks pregnant. She asks the practical nurse, “Do you think I should have an abortion?” Which of the following statements by the practical nurse is the most appropriate? 1. “It would probably be best for the baby and you.” 2. “Do you think you would feel guilty if you had an abortion?” 3. “What do you think would be the best thing for you to do?” 4. “What do your parents want you to do?” 42. Ms. Lee is a sex worker. She asks the practical nurse what she should use for contraception and prevention of sexually transmitted infections (STIs). Which of the following methods of prevention would be recommended by the practical nurse? 1. A diaphragm 2. A spermicide 3. A cervical cap 4. A female condom 43. Ms. McLeod has a positive test result for human papilloma virus (HPV). What should the practical nurse discuss with Ms. McLeod regarding future health care? 1. The need to have routine Papanicolaou (Pap) tests 2. The importance of finishing her prescribed antibiotics 3. That she should abstain from sexual intercourse to prevent transmission 4. If her treatment involves cryotherapy, that she will no longer be infectious to her sexual partners 44. A cardiologist has recommended to Ms. Ahmadi, age 42 years, that she should never become pregnant due to her severe heart failure. Ms. Ahmadi has complied with this recommendation and asks the practical nurse what form of birth control would be the best option for her. What information should the practical nurse provide? 1. “Your best option is the oral birth control pill.” 2. “A tubal ligation is almost 100% effective.” 3. “I’d suggest your partner have a vasectomy.” 4. “An intrauterine device is easily inserted and is an effective birth control method.” END OF CASE 9 Case 10 The World Health Organization has predicted that a pandemic form of influenza will spread to Canada. A vaccine has been rapidly manufactured, and health care providers are preparing for mass immunizations and caring for acutely ill, infected people. QUESTIONS 45 to 50 refer to this case. 45. Health care workers are a priority group to receive the vaccine. A practical nurse is concerned about receiving this new vaccine, as the media have reported that it is not safe. What should the practical nurse do? 1. Not have the vaccine because safety is in question 2. Research reputable resources for information on the safety of the vaccine 3. Have the vaccine in order to protect the practical nurse and her clients from the flu 4. Discuss with nursing colleagues their opinions about the vaccine 46. A practical nurse cares for her older adult mother and has two young children. She feels that if a pandemic occurs, she will have to make a choice between caring for her clients and protecting the health of her family. What term relates to this situation? 1. Ethical dilemma 2. Ethical theory 3. Moral distress 4. Nonmaleficence 47. A practical nurse is aware that this pandemic situation will result in limited resource allocation. She wonders who will receive priority treatment if many acutely ill people require intensive hospital care. Which of the following guidelines would most likely be recommended? 1. Older, frail adults receive priority care, as they are more at risk. 2. Healthy adults receive the resources, as they are most likely to survive. 3. The federal government legislates who the at-risk groups are for treatment. 4. Local, provincial, federal, and international pandemic planning committees identify priorities. 48. A practical nurse is participating in a large community influenza vaccine clinic. The vaccine is to be delivered by injection in a 0.5 mL volume per dose. How would the practical nurse landmark to inject in the most appropriate muscle for older children and adults? 1. Midpoint of the lateral aspect of the upper arm, about 3 to 5 cm below the acromion process 2. The centre of the triangle of the index finger pointing to the anterior superior iliac spine and middle finger along the iliac crest toward the buttock 3. Divide the buttocks into quadrants; the site is in the middle of the upper outer quadrant 4. Middle third of the anterior lateral aspect of the thigh 49. Which of the following questions would the practical nurse ask prior to administering the influenza vaccine to a 20-year-old man? 1. “Have you ever had an allergic reaction to the influenza vaccine?” 2. “Are you sexually active?” 3. “Have you ever had influenza?” 4. “Are your childhood immunizations up to date?” 50. A mother brings her priority-listed asthmatic daughter to be immunized at the vaccine clinic. She also brings in her teenage son and requests that he receive the vaccine. At this time, well adolescents are not on the priority list for the vaccine. What should the practical nurse do? 1. Give the vaccine to the adolescent son 2. Tell the mother her teenage son is not allowed to have the vaccine 3. Inform the mother her teenage son is not at risk for getting the pandemic influenza, so he does not need to have the vaccine 4. Explain to the mother why her adolescent son is not in a priority group at present and tell her that he will likely be able to be vaccinated at a later date END OF CASE 10 Case 11 A practical nurse is working in a long-term care facility. Ms. Smith, age 87, is admitted to the facility. QUESTIONS 51 to 53 refer to this case. 51. Ms. Smith tells the practical nurse that she might as well die now, as she has no family left to care for her. Which of the following responses by the practical nurse would be most therapeutic? 1. “Don’t worry; you will soon make new friends here.” 2. “I know it must be hard for you, but you will soon settle in.” 3. “Let me get us some tea, and we can talk about how you are feeling.” 4. “Why don’t we go down to the lounge, and I will introduce you to some other residents.” 52. Ms. Smith is mobile but spends most of her day sitting in a chair. Staff members have told her on many occasions that she needs to exercise and have explained the benefits of regular exercise for her mobility and cognitive function. Ms. Smith has said, “I am aware of the benefits of exercising, but I have never been one to enjoy exercise, and I am not going to start now.” What should the practical nurse do? 1. Move the chair from her room so she is not able to sit in it 2. Take her to the agency exercise classes 3. Assess Ms. Smith’s cognitive abilities and need for a substitute decision maker (SDM) 4. Respect her decision and continue to encourage exercise 53. Ms. Smith tells the practical nurse she appreciates her care and concern so much that she would like to give her a gift as a thank-you. She hands the practical nurse a diamond and emerald brooch. What should the practical nurse do? 1. Accept the gift if Ms. Smith is cognitively intact and aware of the value of the brooch. 2. Tell Ms. Smith that since the gift is quite valuable, it is best to leave it to the practical nurse in her will. 3. Thank Ms. Smith but explain it is against professional ethics to accept expensive gifts from clients. 4. Tell Ms. Smith agency policies do not permit nurses to accept any type of gift from clients. END OF CASE 11 Case 12 Mr. Hudson is a 53-year-old man who has been diagnosed with type 2 diabetes. He is referred to the practical nurse for education about his disease. He is somewhat overweight and requires education about nutrition for weight loss and diabetes management. QUESTIONS 54 to 60 refer to this case. 54. After developing a rapport with Mr. Hudson, what would be the most appropriate initial strategy for the practical nurse to use with Mr. Hudson at his first learning session? 1. Provide him with a list of “dos and don’ts” about his diet 2. Explain the need for a balanced diet to regulate his blood sugar and lose weight 3. Ask him what behaviours he would like to change 4. Ask him what he would like to learn from nutrition counselling 55. Which of the following would be a key concept in meal planning for Mr. Hudson? 1. Smaller meals at frequent intervals 2. Decreased carbohydrate intake 3. Vitamin and mineral supplements to replace deficiencies in food intake 4. Reduced total fat 56. Baked beans, whole grain cereals, flax seed, brown rice, and soybeans are recommended for a healthy diet. They are examples of which of the following types of carbohydrates? 1. Simple carbohydrates 2. Complex carbohydrates 3. Monounsaturated carbohydrates 4. High-glycemic-index carbohydrates 57. Mr. Hudson asks the practical nurse how he can lower his intake of saturated fats. Which of the following foods would the practical nurse recommend that Mr. Hudson avoid? 1. Fish 2. Canola oil 3. Whole milk 4. Omega 3 trans-fat-free soft margarine 58. Mr. Hudson asks the practical nurse what would be a good breakfast for him, considering his diabetes and that he would like to lose weight. Which of the following menus would be the most appropriate? 1. One bran muffin with margarine, half a grapefruit, and a glass of orange juice 2. A poached egg, one slice of whole-wheat toast, a glass of skim milk, and an apple 3. Two slices of crisp bacon, scrambled eggs, and green tea 4. One cup of raisin bran cereal with lactose-free milk and a glass of grapefruit juice 59. One month after Mr. Hudson’s visit to the diabetes clinic, he calls the practical nurse to say that he is sick with gastroenteritis and had vomited a small amount of emesis once earlier in the morning. He wants to know what to do about his medications and food. How should the practical nurse advise Mr. Hudson? 1. Not to take his oral hypoglycemic pills and to drink as much sweetened juice as he is able 2. Maintain his normal diabetes medications, monitor his blood sugar every 3 to 4 hours, and drink frequent sips of carbohydrate fluids as required 3. Contact his doctor for instructions 4. Take half the usual dose of his oral hypoglycemic pills and sip fluids every hour 60. Mr. Hudson comes back to the clinic 3 months after his first visit. Which of the following would be the best criterion for evaluating the status of his type 2 diabetes? 1. A weight loss of 5 kg 2. A fasting blood-sugar reading of 6.5 mmol/L 3. A glycosylated hemoglobin (HbA1c) test reading of 5.9% 4. A statement by Mr. Hudson that he feels well and is managing the disease END OF CASE 12 Case 13 Tiffany, age 15 years, is admitted to an eating disorders unit at a general hospital because of severe malnutrition. She has a history of self-restricted food intake and excessive exercising over the past 2 years. She is assessed to be below 60% of the expected normal body weight for her height. Her practical nurse performs an admission health history. QUESTIONS 61 to 67 refer to this case. 61. The practical nurse asks Tiffany about her health history. What might the practical nurse expect Tiffany to tell her? 1. “I feel really hot sometimes.” 2. “I stopped menstruating when I was 14.” 3. “My skin is really oily.” 4. “I get diarrhea quite often.” 62. Which of the following blood tests would be most important for Tiffany? 1. Sodium 2. Potassium 3. Electrolytes 4. Chloride 63. The practical nurse interviews Tiffany’s parents. Which of the following descriptions might her parents use for Tiffany? 1. “We suspect she is promiscuous.” 2. “Tiffany openly discusses her anorexia with us.” 3. “She often acts out and is difficult to manage.” 4. “Tiffany is a high achiever at school.” 64. The practical nurse takes Tiffany’s vital signs later that night while Tiffany is sleeping. She discovers that Tiffany’s apical rate is 41 beats per minute. What is the appropriate initial nursing intervention? 1. Immediately notify the on-call physician 2. Monitor the apical rate every hour until it increases and stabilizes 3. Wake Tiffany and have her drink a glass of juice or water 4. Bring Tiffany a snack of her preferred food 65. When Tiffany’s vital signs stabilize, she is permitted to walk around the unit. The practical nurse plans to monitor Tiffany’s physical activity. What is the primary rationale for this intervention? 1. Adolescents with anorexia may secretly exercise as a weight-loss activity. 2. Tiffany is so malnourished that physical activity will be harmful. 3. Regular physical activity is an important component of the therapeutic plan. 4. Exercise will improve Tiffany’s ability to tolerate the increased nutritional intake. 66. Tiffany is scheduled to attend group sessions with the other adolescent girls on the unit who have anorexia. Tiffany says, “I don’t want to sit around with a bunch of silly girls. Do I have to go?” What would be the best response from the practical nurse? 1. “I think you need their support.” 2. “Let’s talk about your feelings about not going to these meetings.” 3. “No, it is best to wait until you feel you really need to talk with other girls.” 4. “Yes, because the group sessions will help you cope with your anorexia.” 67. Which of the following dietary goals would be appropriate for Tiffany? 1. Tiffany will consume a high-calorie diet to promote rapid weight gain. 2. Tiffany will eat a prescribed diet to ensure gradual weight gain. 3. Tiffany will drink 3 L of water a day to ensure adequate hydration. 4. Tiffany will gain 1 kg per week. END OF CASE 13 Case 14 A practical nurse works at a community health clinic. She receives a call from Ms. McColm, the mother of a 3-week-old infant. QUESTIONS 68 to 71 refer to this case. 68. Ms. McColm is worried that her 3-week-old infant might be sick. What would be a significant manifestation of illness in an infant of this age? 1. A red, papule-type rash on the face 2. Long periods of sleep 3. Grunting and rapid respirations 4. Desire for increased fluids during the feedings 69. Ms. McColm tells the practical nurse her infant “feels warm.” By which of the following methods would the practical nurse recommend that Ms. McColm take the infant’s temperature? 1. Oral 2. Rectal 3. Axillary 4. Tympanic 70. Ms. McColm determines that the infant’s temperature is 38.9°C. What should the practical nurse recommend? 1. “Give the infant extra fluids.” 2. “Bring the infant to the clinic to see the physician.” 3. “Monitor the temperature every 4 hours for the next several days.” 4. “Administer infant acetaminophen (Tempra).” 71. The practical nurse documents this telephone consultation using computer charting. Which of the following is an accurate statement regarding computerized documentation? 1. Each nurse must have an individual and secret password. 2. Clients are not allowed to view their computerized health records. 3. Client permission is required prior to accessing any health record. 4. Research has shown that more documentation errors occur with computer charting. END OF CASE 14 Case 15 A rural community has a program to provide support to older persons to enable them to live independently for as long as possible in their own homes. A practical nurse leads this community initiative. QUESTIONS 72 to 75 refer to this case. 72. Many of the practical nurse’s clients do not have a great deal of money. What is the most important factor to consider when caring for clients who have limited financial resources? 1. They will have decreased access to the health care system. 2. They may have low self-esteem related to the stigma of poverty. 3. Their basic physical needs may not be met. 4. There is often a lack of client compliance with recommended treatment. 73. The practical nurse visits the home of Ms. Gash, an active 84-year-old client. Which of the following would most concern the practical nurse about Ms. Gash’s home environment? 1. It is a wood-frame house. 2. There is a small throw rug on the hardwood floor. 3. It has a microwave oven. 4. There is electric heating from baseboard heaters. 74. Many of the practical nurse’s clients are concerned about “moving their bowels.” Which of the following recommendations would the practical nurse suggest to help prevent constipation in an older client? 1. Fibre in the form of bran and fresh fruits 2. Cellulose in the form of corn on the cob and rice 3. Natural laxatives in the form of bananas and milk 4. Peristalsis stimulators in the form of echinacea 75. The local health department has issued a pollution alert on a hot, humid day. Mr. Scanlon, who has chronic obstructive pulmonary disease (COPD), phones the practical nurse to ask what he should do. What should the practical nurse advise? 1. To stay inside his air-conditioned house 2. To carry on with his ordinary activities 3. To contact his respiratory therapist for advice 4. To increase his inhaled medications END OF CASE 15 Case 16 Ms. Merkel, a woman who lives in a self-sufficient religious community, has been admitted to hospital with severe pulmonary fibrosis. QUESTIONS 76 to 78 refer to this case. 76. When providing care for Ms. Merkel, how should the practical nurse assess and treat her? 1. In accordance with known religious beliefs 2. According to her individually expressed needs 3. In compliance with guidelines that her family has provided 4. No differently from the other clients on the unit 77. Ms. Merkel refuses to allow Alex, a male nurse, to care for her as she says it would be considered inappropriate in her community. She insists that she have a female nurse. What should Alex do? 1. Arrange for a change-of-client assignment to a female nurse 2. Discuss with Ms. Merkel why she wishes not to have a male nurse 3. Tell Ms. Merkel that in Canadian society the rights of male nurses are respected 4. Tell Ms. Merkel she must accept him as her nurse because the charge nurse assigned him 78. Due to the severity of her illness, Ms. Merkel dies. Before performing end-of-life care for the body, what should the practical nurse do? 1. Arrange for Ms. Merkel’s relatives to see her 2. Ensure Ms. Merkel’s wishes regarding organ donation have been discussed with the family 3. Identify any cultural death rites that must be respected 4. Avoid touching the body until the religious leader has provided permission END OF CASE 16 Case 17 Ms. Lesley is admitted to the postpartum unit with her full-term newborn son Lee, after having a caesarean section. QUESTIONS 79 to 82 refer to this case. 79. Ms. Lesley received a caesarean section due to untreated genital herpes. What would be the danger to the infant if she were to have delivered vaginally? 1. Thrush 2. Systemic herpes 3. Ophthalmia neonatorum 4. Neurological complications 80. The practical nurse obtains an oxygen saturation reading of 87% on 2-hour-old Lee, who is not experiencing respiratory distress. What initial action should he take? 1. No action is required 2. Contact the physician 3. Administer ordered oxygen 4. Place the infant in a humidified Isolette 81. During the examination of newborn baby Lee, the practical nurse notes that he has asymmetric gluteal folds. Which of the following conditions does this indicate? 1. Central nervous system damage 2. A dislocated hip 3. An inguinal hernia 4. Peripheral nervous system damage 82. Baby Lee has had a circumcision. What is the m

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