Hesi lpn exit proctored exam
Which action should the practical nurse (PN) implement when performing a focused assessment?
Explanation & Rationale
A. Wear clean gloves during auscultation of a client's heart sounds, lung sounds, and bowel sounds. Gloves not required for auscultation unless contact with body fluids is anticipated. B. Dispose of gastric residual volume obtained when aspirating a client's nasogastric tube: Standard practice unless facility policy specifies reinsertion; prevents aspiration risk. C. Weigh mother holding infant then subtract the mother's weight to obtain the infant's weight: Not part of a focused assessment but a measurement technique. D. Place BP cuff on thigh of a client with burns to the upper extremities: Adaptation for burn injuries but not related to general focused assessment steps.
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