Mixed Deck — All CPNRE Topics Flashcards

A practical nurse is teaching a client about lifestyle modifications to prevent cardiovascular disease. Which instruction is MOST important?

Answer: Perform aerobic exercise for at least 150 minutes per week

Regular aerobic exercise at the recommended level is one of the most evidence-based strategies for cardiovascular disease prevention, reducing risk factors comprehensively.

Which of the following scenarios constitutes a breach of client confidentiality by a practical nurse?

Answer: Discussing a client's difficult diagnosis with a spouse who is not the designated substitute decision-maker, without the client's consent.

Licensed Practical Nurses have a legal and ethical duty to protect the privacy and confidentiality of a client's personal health information. Disclosing information to anyone outside the immediate circle of care, including a spouse, without the client's explicit consent is a breach of this duty. Sharing information during shift report, with the pharmacist for medication safety, or with other members of the interdisciplinary team for care planning are all appropriate and necessary communications for providing safe care.

A practical nurse working on a medical unit is assigned to care for four patients: a patient in airborne precautions for measles, a patient in droplet precautions for influenza, an immunocompromised post-chemotherapy patient in protective isolation, and a patient with a MRSA wound infection in contact precautions. In what order should the nurse see these patients to minimize infection transmission risk?

Answer: Immunocompromised protective isolation patient → influenza droplet patient → MRSA contact patient → measles airborne patient

The immunocompromised patient in protective (reverse) isolation should be seen first, as this patient is most vulnerable to acquiring infections from the nurse. The influenza patient (droplet) poses less transmission risk via indirect contact than the MRSA patient (contact — direct touch of infected surfaces/wound). The MRSA wound patient is seen before the measles patient because, while both require extra precautions, the measles patient poses the highest environmental contamination risk through airborne spread. Saving the highest-risk transmitter for last minimizes carry-over risk to subsequent patients.

When performing a mental status assessment, which component does the practical nurse evaluate by asking the client to subtract serial 7s from 100?

Answer: Concentration and calculation

Serial 7 subtraction tests concentration and calculation ability, which is a component of cognitive function in a mental status exam.

An old guy is admitted to a nursing home, suffering from dementia. When his wife initially visits her husband, she seems weak, worn out, and irate. Her caustic answer to the unit nurse is, "Let's see what you can do with him." The nurse's most helpful response to this would be:

Answer: Taking care of him must have been incredibly challenging.

The wife's demeanor and caustic comment indicate profound exhaustion, frustration, and possibly guilt from the immense burden of caring for a spouse with dementia. An empathetic response like 'Taking care of him must have been incredibly challenging' validates her feelings and acknowledges the difficulty of her situation. This approach builds trust and rapport, showing the nurse understands her struggles rather than being defensive or dismissive.

A practical nurse is assigned care that requires competencies they do not possess. What is appropriate?

Answer: Inform the charge nurse of the competency gap and request assistance, reassignment, or supervised practice

Practical nurses must practice only within their competence. Identifying a competency gap to the charge nurse is the professional obligation.

A PN is employed by a staffing agency and is placed at a hospital where they are asked by the charge RN to perform a task that falls within RN scope but outside PN scope in that province. The charge RN asserts that the hospital policy permits PNs to perform this task. What is the MOST appropriate action?

Answer: Decline the task, explaining that provincial nursing legislation and PN scope of practice take precedence over hospital policy

Scope of practice is defined by provincial nursing legislation and the PN's regulatory body — not by employer or facility policy. A hospital cannot expand a PN's legal scope of practice through internal policy, nor can a supervisor's instruction override provincial law. Performing a task outside one's legislated scope exposes the PN to regulatory discipline and civil liability regardless of who directed them. The PN must decline and escalate appropriately. Contacting the staffing agency is a secondary step, but does not change the legal obligation to decline.

A nurse is caring for a newborn at 2 hours of life whose mother received magnesium sulfate for 14 hours prior to delivery. The infant's respiratory rate is 38 breaths/min, tone is decreased, and the Moro reflex is absent. Which nursing intervention is MOST appropriate?

Answer: Prepare calcium gluconate 200 mg/kg IV and notify the neonatal team immediately

Neonatal hypermagnesemia from transplacental transfer can cause respiratory depression, hypotonia, and absent reflexes. The antidote for magnesium toxicity in neonates is calcium gluconate, not naloxone (which reverses opioids). Calcium gluconate 200 mg/kg IV slowly is the recommended treatment and must be prepared immediately while the neonatal team is notified for close respiratory monitoring and potential intubation support.

A client with a nasogastric tube is receiving continuous enteral feeding. Which nursing action is the highest priority?

Answer: Elevate the head of the bed to at least 30-45 degrees

Elevating the head of the bed to 30-45 degrees is the highest priority to prevent aspiration pneumonia in clients receiving enteral feedings.

A PN is caring for a 65-year-old client admitted for decompensated liver cirrhosis with ascites and hepatic encephalopathy (Grade II). The client is currently receiving lactulose 30 mL PO TID. Morning labs return: sodium 128 mmol/L, potassium 3.1 mmol/L, creatinine 198 µmol/L, ammonia 112 µmol/L. The client becomes increasingly agitated and attempts to climb out of bed. Which intervention requires a physician order BEFORE the PN can implement it?

Answer: Applying a physical restraint to prevent the client from falling

Physical restraints are a regulated intervention in Canadian nursing practice and require a physician order before application, except in situations of immediate life-threatening emergency where documentation and physician notification must follow immediately. In this scenario, the client is agitated but not in immediate mortal danger from a single repositioning attempt, making least-restraint alternatives (alarms, family presence, reorientation, environmental modifications) the required first steps. Applying restraints without an order — even in hepatic encephalopathy — violates restraint legislation and professional standards. Side rail policy varies by jurisdiction (raising all 4 may be considered a restraint in some provinces). Reorientation and family engagement are independent nursing actions. Neurological documentation is a core PN function requiring no order.

A practical nurse witnesses a colleague falsifying a client's vital signs documentation. What is the ethical and professional obligation?

Answer: Report the behavior through appropriate channels (charge nurse, management, regulatory college if required)

Falsifying health records is a serious professional offence requiring mandatory reporting through appropriate channels to protect client safety.

A practical nurse is assisting with feeding a client who has dysphagia following a stroke. Which intervention is a priority to prevent aspiration?

Answer: Positioning the client in an upright, 90-degree angle.

Positioning the client fully upright (90-degree angle or high-Fowler's position) is the most critical intervention to prevent aspiration. This position uses gravity to facilitate the passage of food and liquid down the esophagus and away from the trachea. The client should remain upright for at least 30 minutes after the meal.

Which communication technique is most therapeutic when a client says, 'I feel like no one cares about me'?

Answer: 'It sounds like you're feeling alone and unsupported.'

Reflecting and paraphrasing the client's feelings validates their experience and encourages further expression without dismissing or challenging the statement.

A client begins sharing personal details about their private life during every interaction. Which nursing response best maintains the therapeutic relationship?

Answer: Gently redirect conversations to focus on the client's health and goals.

Redirecting conversations to health-focused topics maintains professional boundaries while preserving a respectful, therapeutic relationship.

A practical nurse is preparing to administer methotrexate 15 mg orally to a client with rheumatoid arthritis. The pharmacy has dispensed methotrexate 2.5 mg tablets. The nurse calculates a dose of 6 tablets. Before administering, which action is MOST critical given methotrexate's high-alert status?

Answer: Contact the prescriber to verify whether the order is a weekly dose before administering

Methotrexate for non-oncologic indications (e.g., rheumatoid arthritis) is prescribed WEEKLY, not daily. Daily administration of methotrexate in this context is a known, potentially fatal medication error. The nurse must verify the dosing frequency with the prescriber before administering 6 tablets, as this dose given daily could cause severe toxicity. Independent double-checking and clarification of high-alert medications is a mandatory safety step.

Which statement best describes 'unconditional positive regard' as applied to therapeutic nurse-client relationships?

Answer: The nurse accepts the client as a person of worth regardless of their behaviors or values

Unconditional positive regard means accepting the client as a person of inherent worth and dignity, separate from their behaviors, values, or decisions, without conditions or judgment.

A client in the PACU has respiratory rate 8 breaths per minute and SpO2 91% after abdominal surgery. What is the priority nursing action?

Answer: Stimulate the client to breathe by calling their name and applying tactile stimulation if needed

Post-anesthesia respiratory depression requires immediate stimulation of the client to breathe, supplemental oxygen, and readiness for additional intervention.

A nurse self-discloses personal information to a client to 'even the playing field.' This behavior is best described as:

Answer: A boundary violation that shifts focus from the client to the nurse.

Excessive or inappropriate self-disclosure violates therapeutic boundaries and redirects focus away from the client's needs.

A PN who disagrees with a physician's order should first:

Answer: Clarify the order directly with the physician and express concerns professionally

PNs have a professional responsibility to question orders that appear unsafe or unclear through direct, respectful communication with the prescriber.

A practical nurse notes that a physician's handwritten order in a client's chart is illegible. What is the most appropriate action for the nurse to take?

Answer: Contact the prescribing physician directly to clarify the order.

To ensure client safety and prevent medication errors, the practical nurse must never guess or assume what an illegible order says. The only safe and acceptable action is to contact the original prescriber for clarification before preparing or administering the medication.