Free Generic Employment Application for California

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Free Generic Employment Application for California Powered By Docstoc
					               LICENSED VOCATIONAL NURSE/LICENSED PRACTICAL NURSE
             CALIFORNIA CORRECTIONAL EMPLOYMENT APPLICATION PACKET
Welcome to Star Nursing, your Nurse Registry that is owned and operated by Registered Nurses. We
specialize in offering the finest, most experienced nurses for staffing support throughout the United
States with multiple needs in Arizona, California, Florida, Louisiana, and Texas.

Please use this letter as your checklist for your application. Star Nursing staffs multiple health care
facilities and Correctional locations. Since you have expressed and interest in working at Correctional
Facilities, please provide all the completed forms in the Application Forms table and copies of all the
required current documents. You may tab though this Application Packet and type to complete the
forms. When complete return via email to your recruiter at name@starnursing.com or email to
recruiter@starnursing.com.

                                            APPLICATION FORMS
    Employment Application
    Application Employment Verification
    State Tax Form
    Employment Eligibility Verification (I-9 form)
    Tax Home (if Traveling Nurse)
    Notification and Release Form
    Paycheck Automatic Withdrawals and Deposits
    Medical Release Agreement
    LVN/LPN Job Description
    LVN/ LPN Skills
    LVN/ LPN Test
    LVN/ LPN Pharmacology Test

                                   REQUIRED CURRENT DOCUMENT COPIES
    Resume
    Driver’s License
    Social Security Card or other I-9 documentation
    Nursing License (for each state)
    CPR or any pertinent licensure/ certification
    TB or Radiology report (within 3 months)


Once we have received your application and complete our verification, we will actively seek an
assignment that matches your background and qualifications. Please do not hesitate to call with any
questions or concerns you may have. For Correctional Facilities you will also be receiving paperwork
for gate clearance separately. You must be gate cleared in order to be offered a position at the
Correctional Facility and you will be required to attend an orientation at the Correctional Facility that
may be from one week to three weeks long.


                                               WELCOME ABOARD!


                                       CA Correctional LVN LPN Employment Application Packet v-2 121007            Page 1 of 18
 5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                  Tel: 877.687.7399             Fax: 877.687.7400
                                                                       Employment Application
                                                                                       Personal
  Name:              ,                                                                                                                         SSN:
                                 Last                                                   First                                 Initial
  DOB:                                Address:                                                                                       ,
               M/D/YY                                                   Street & Number                                       City                         State           Zip Code
  Phone Numbers:
                                           Home                                                        Cell                                                        Fax
  Email:                                                                                                                        Preferred Contact Method:

  Emergency contact name and phone number:
                                                                                          Name                                                              Number
  Have you ever been convicted of a felony or misdemeanor?                                 yes          no Drivers License#:                                              Exp.
  How were you referred to us?                                                                  Please enter Employee referral name:
                                                                                      Preferences
  Facility Preference:               Hospital         Correctional          Employment Type:                  Traveler        Per Diem                Full Time            Part Time
  Available Shifts:          Days               Evenings           Nights                 Preferred Shift Hours          8               12                  Start Date:
  Preferred Location:
                                                                                      Specialties
     ER          ICU          NICU              PACU          PICU          Pediatric           Psychiatry         SUV           TCU              Telemetry              Med/Surg

     Maternal/Nursery                 NP        Perioperative               CNA                 LVN/LPN            {other}       {other}
                                                                                       Licenses
                                         Professional Licenser                                                   Professional License Type                  Exp. Date             State




  Pertinent Certifications/Licenses:
  CPR        , ACLS
         Exp. Date       Exp. Date                Exp. Date              Exp. Date                   Exp. Date                 Exp. Date                    Exp. Date              Exp. Date


                                                                                      Education
                                                                                                                                                                             Degree
    School Type                  Name of School                                      Location                                Major             # of Yrs.       Degree
                                                                                                                                                                              Date
  High School
  Junior College




                                                              CA Correctional LVN LPN Employment Application Packet v-2 121007                                     Page 2 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                                         Tel: 877.687.7399                           Fax: 877.687.7400
                                                                  Employment History
  May we contact your employer?          yes           no               Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -            Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  May we contact your employer?          yes           no               Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -            Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  May we contact your employer?          yes           no               Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -            Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  May we contact your employer?          yes           no               Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -        Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  May we contact your employer?          yes           no               Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -            Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  May we contact your employer?          yes           no             Employer:
  Facility:                                                    Address:                                                    Phone:
  Unit:                                                             Dates of Employment:                 -            Salary:
  Reason for Leaving:                                                                                  Name of Supervisor:
  I I hereby certify that the information contained in this application is true and correct to the best of my knowledge, and authorize the company to
  verify any of the statements or information provided herein. I also authorize Star Nursing to review any credit reports, Department of Motor Vehicles
  records and criminal records concerning me. I further authorize Star Nursing to contact the references listed regarding my past and current
  employment. I understand that any misrepresentation or falsification, or material omission of information on this application may result in my failure
  to receive an offer or, if hired, my dismissal from employment and that any position where I shall be working indirectly for a Federal Agency that I
  understand that a false statement rendered by myself may result in the federal punishment for perjury.

  Furthermore, Star Nursing may share all employment documentation clients, subsidiaries, customers, affiliates, and government agencies and send
  me employment opportunity related information at fax numbers or email addresses listed in this application.


  Signature:                                                                                                                            Date:
      I                                                   agree that I am submitting this and other documents electronically and have typed
      my name above and dated in the Signature Space in lieu of an original signature and hereby authorize Star Nursing and its affiliates to
      utilized the submitted documents for the purposes noted on this release and on other Star Nursing documents.



                                                 CA Correctional LVN LPN Employment Application Packet v-2 121007                    Page 3 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                       Tel: 877.687.7399                   Fax: 877.687.7400
                                          APPLICANT EMPLOYMENT VERIFICATION
   Applicant, Please Complete:

   Former Employer Information
       Facility:
       Address:
                     #           Street


                                                     City                                    State                  Zip Code
       Phone #:                                              Supervisor:
       Dates of Employment:                   From:                                            To:
       Unit:                                                         Title:
   I herby authorize any individual, hospital or company with whom I have been associated to furnish any information
   concerning my employability and do herby release the individual, hospital or company from all liability for any
   damages whatsoever incurred in furnishing such information. By typing your name below you agree to the above
   and are authorizing submission of your application employment verification electronically, otherwise please sign
   and return the Application Employment Verification by email (scan), fax or mail (original).

                    Print Name                                                   Signature                                     Date



   Employer Please Complete:

   Was the applicant employed by you?                       yes      no Position:
   Dates of Employment: From:                                To:              Would you re-employ this applicant?               yes         no
   If no, why?
     Please rate applicant in the following category:
                                                                     Excellent               Good            Fair          Weak
      Knowledge of work
      Quality of work
      Professional appearance
      Attitude
      Character
      Leadership
      Attendance
   Comments:


                   Name of person making reference                                                   Title                       Date


                                          Thank You for Taking Time to Fill Out this Form
                                           CA Correctional LVN LPN Employment Application Packet v-2 121007                           Page 4 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                               Tel: 877.687.7399                 Fax: 877.687.7400
                                              APPLICANT EMPLOYMENT VERIFICATION
      Applicant, Please Complete:

      Former Employer Information
           Facility:
           Address:
                         #           Street


                                                         City                                    State                  Zip Code
           Phone #:                                              Supervisor:
           Dates of Employment:                      From:                                         To:
           Unit:                                                         Title:
      I herby authorize any individual, hospital or company with whom I have been associated to furnish any information
      concerning my employability and do herby release the individual, hospital or company from all liability for any
      damages whatsoever incurred in furnishing such information. By typing your name below you agree to the above
      and are authorizing submission of your application employment verification electronically, otherwise please sign
      and return the Application Employment Verification by email (scan), fax or mail (original).

                        Print Name                                                   Signature                                     Date



      Employer Please Complete:

      Was the applicant employed by you?                        yes      no Position:
      Dates of Employment: From:                                 To:              Would you re-employ this applicant?               yes      no
      If no, why?
         Please rate applicant in the following category:
                                                                         Excellent               Good            Fair          Weak
          Knowledge of work
          Quality of work
          Professional appearance
          Attitude
          Character
          Leadership
          Attendance
      Comments:


                       Name of person making reference                                                   Title                       Date


                                               Thank You for Taking Time to Fill Out this Form.
                                              CA Correctional LVN LPN Employment Application Packet v-2 121007                     Page 5 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                              Tel: 877.687.7399                  Fax: 877.687.7400
                                                                   Notification and Release
The information contained in my application for employment with Star Nursing, is true to the best of my knowledge and belief. I understand that any
misrepresentation or false statement made by me in connections with the application or any related documents which is deemed material by Star Nursing,
shall result in Star Nursing, not employing me or, if employed, terminating my employment. I understand and agree that all information furnished in my
application and all attachments may be verified by Star Nursing, or it’s authorized representative. I hereby authorize all individuals and organizations
named or referred to in my application and any law enforcement organization to give Star Nursing , all information relative to such verification and hereby
release such individuals, organizations, and Star Nursing from any and all liability for any claim or damage resulting therefrom. I hereby acknowledge
that I have been informed by Star Nursing, that Star Nursing may seek to obtain a consumer report and/or investigative report that will include personal
information regarding me, including but not limited to, educational history, work references, driving records and criminal history or criminal arrest records
if allowed, in order to assist Star Nursing , in making certain employment decisions. I further acknowledge notification by Star Nursing, that reports may
be provided to Star Nursing by other firms subcontracted for that purpose. I, my heirs, assigns and legal representatives, hereby release and fully
discharge Star Nursing it’s parents and affiliated companies and the respective officers, directors, shareholders, employees, agents of each, including
subcontractors from any and all claims, monetary or otherwise, that I may have against Star Nursing , its parent, affiliates or subcontractors, arising out of
the making, or use of, either a consumer report and/or investigative report , including any errors or omissions contained or omitted from such reports or
investigations. Star Nursing agrees to inform you if an employment decision has been influenced by information contained in a consumer report. Make
all request in writing to OccuTest, LLC P.O. Box 10741 Raleigh, NC 27605 or call 919-861-0801 to obtain a free copy of your report.

List all names that you have used during the last seven-(7) years (including married, maiden, and aliases) Please Print

Name (First, Middle, Last): ___________________________________________Date of Birth _______________

Maiden Name ___________________________________________________Dates Used ______________________

Social Security #___________________________________Driver’s License # _________________ State ______________

Current and Previous Addresses ( Use extra page if necessary)

Street ________________________________________________________________From: _____________________

City, State, County _____________________________________________To: ______________________

Street _______________________________________________________________ From: _____________________

City, State, County _____________________________________________________To: ______________________

Street ________________________________________________________________From: _____________________

City, State, County _____________________________________________________ To: ______________________

Street ________________________________________________________________From: _____________________
                                                   EDUCATION INFORMATION

     College:______________________________________                     Address: _________________________

     Campus attended: _____________________________                        Phone Number: _____________________________
                                                                                       Yes No
     Dates attended: From:_____________ To:____________              Did you graduate?                  Degree:____________________
     College:______________________________________                     Address:________________________________________

     Campus attended: _____________________________                        Phone Number: _____________________________
                                                                                       Yes No
     Dates attended: From:_____________ To:____________              Did you graduate?                  Degree:____________________

Applicant Signature: ____________________________________________________Date ______________________

Fax to OccuTest: (919)- 861-0803 or call (919) 861-0801 to speak with a customer service representative.
   Federal Criminal Nationwide                                                                               Social Security Number Verification
   Statewide Criminal Search________                                                    _______
                                                                                                                                         Page 6 of 18

           5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664 Phone: 877.687.7399                                     Fax: 877.687.7400
                        MEDICAL RELEASE
                  HEALTH INFORMATION DISCLOSURE


 I hereby authorize Star Nursing Agency, Inc. to disclose any and all
 health screening to Medical Facilities within the USA; for purpose
 of regulatory document management of Agency personnel.




 Employee Name:                                                         Date:



 Signature:



 Star Nursing Rep:                                                      Date:



         I                                   agree that I am submitting this document
         electronically and have typed my name in the signature line above in lieu of an
         original signature and dated above and hereby authorize Star Nursing and its affiliates
         to utilize this submitted document.




                                                                                         Page 7 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664 Phone: 877.687.7399    Fax: 877.687.7400
                               LICENSED VOCATIONAL NURSE
                                    JOB DESCRIPTION

  Education and Experience Requirements: Must have graduated from an accredited school of
  Licensed Vocational Nursing, hold a current state license, and have a minimum of three years of
  hospital experience.


  Position Summary: The Licensed Vocational Nurse will be under the general direction of the
  Director of Nursing, and under the direct direction of the RN, and Charge Nurse as identified by
  the facility in which the nurse is placed. The Licensed Vocational Nurse is responsible for
  skilled nursing care and related assistance to patients on the unit where assigned. The Licensed
  Vocational Nurse provides nursing care pursuant to the objectives of the hospital, and in
  compliance with the Licensed Vocational Nurse Practice Act in the state of practice.

  Agency Nurses are expected to display knowledge and skills necessary to provide care from
  admission to discharge of patients or clients in the home care setting or any other health care
  facility.

  The above statements are intended to describe the general nature and level of work to be
  performed by persons assigned to this classification. They are not to be construed as an
  exhaustive list of all job duties performed by the Licensed Vocational Nurse.




                            Name (Print)




                              Signature                                                           Date

           I                                 agree that I am submitting this document
           electronically and have typed my name above in lieu of an original signature and
           dated and hereby authorize Star Nursing and its affiliates to utilize this submitted
           document.




                               CA Correctional LVN LPN Employment Application Packet v-2 121007                 Page 8 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399            Fax: 877.687.7400
Name:                                                              Date:                   No. of years of experience:

                      LICENSED VOCATIONAL/ PRACTICAL NURSE SKILLS
                                           No      <2       >2                                                No    <2      >2
                                          Exp.     Yrs.     Yrs.                                             Exp.   Yrs.    Yrs.
 Neurological System                                                Cardiovascular System (cont.)
     Neuro assessment                                                Medications:
     Seizure precautions                                                Nitroglycerine SL
  Care of Patients:                                                     Lasix
     Alcohol Withdrawals                                                Digoxin
     ALOC                                                               Dopamine Drip
     CVA                                                                Nitroglycerine Drip
     Drug Overdose                                                  Respiratory System
     Head Injury                                                        Respiratory Assessment
     Seizures                                                           Abnormal lung Sounds
     Spinal Precautions                                              Equipment:
     Suicide precautions                                                Ambu Bag
  Equipment:                                                            Chest Drainage System
     Casts                                                              Nasal Cannula
     Halo Traction                                                      Non-rebreather
     Stryker Frame                                                      Pulse Oximetry
     TENS                                                               Simple Mask
  Medications:                                                          Ventilators
     Ativan                                                          Care of Patients:
     Dialntin                                                           ARDS
     Fosphenytoin                                                       Asthma
     Heparin                                                            Lung Surgery
     Mannitol                                                           Respiratory Failure
     TPA                                                                SOB
     Valium                                                             Tracheostomy
 Cardiovascular System                                               Medications:
     Cardiac assessment                                                 Lasix
     Arrhythmia interpretation                                          Solu-Medrol
  Care of Patients:                                                     Theophylline
     Chest Pain                                                         TPA
     Hip Surgery                                                    Gastro-Intestinal System
     Hypotension                                                        Abdominal Assessment
     Hypertension                                                       NGT Insertion
     Complete heart failure                                          Care of Patients:
     Pacemakers                                                         Abdominal Surgeries
     Post cardiac catheter                                              Acute Abdomen
     Post resuscitation                                                 GI bleed
                                  CA Correctional LVN LPN Employment Application Packet v-2 121007                    Page 9 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                              Tel: 877.687.7399       Fax: 877.687.7400
                                           No      <2       >2                                              No    <2      >2
                                          Exp.     Yrs.     Yrs.                                           Exp.   Yrs.    Yrs.
 Gastro-Intestinal System (cont.)                                   Orthopedic
  Care of Patients (cont.):                                          Care of Patients (cont.):
     NGT/ PEG Feedings                                                  Crutches
     Overdose                                                           Fractures
     Pancreatitis                                                       Hip Surgery
 Urinary System                                                         Immobilizers
     Continuous bladder irrigation                                      Splints
     Clean catch urine                                              Miscellaneous
     Sterile Insertion of Foley                                         Administer Blood Products
     Catheter                                                           Care of Central Lines
     Suprapubic Catheter Care                                           Care of Hemovacs
     Urine Dipstick                                                     Care of Isolation Patients
 Orthopedic                                                             Care of JP’s
     Acute Renal Failure                                                Care of PICC Lines
     Dialysis Patients                                                  Nasopharyngeal suctioning
     UTI                                                                Start I.V.’s
  Care of Patients:                                                     Sterile Dressing Change
     Casts




                                  CA Correctional LVN LPN Employment Application Packet v-2 121007                 Page 10 of 18

5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                              Tel: 877.687.7399     Fax: 877.687.7400
                                              LVN/LPN TEST
  Name:                                                                                Date:

  Please mark your answer to the following questions, print and mark the box you think is correct
  or use a mouse to click the box.

  1.     Mrs. Smith suffers from severe arthritis. The nurse is aware that the term arthritis refers to:
                    (A)    Chronic inflammatory disease of the diarthrodial joints
                    (B)    Acute joint problems
                    (C)    Infectious condition of the joints
                    (D)    Infection of synarthrodial joints

  2.     A patient with rheumatoid arthritis asks if she can substitute acetaminophen (tylenol) for
         her aspirin because it is on sale. The nurse's response will be based on the understanding
         that:
                    (A)    Both can be used interchangeably
                    (B)    Both are analgesic drugs
                    (C)    Acetaminophen (tylenol) increases gastric secretions
                    (D)    Aspirin is an anti-inflammatory drug

  3.     Rehabilitation for a patient with rheumatoid arthritis is directed toward:
                    (A)    Bed rest
                    (B)    Feeding her meals
                    (C)    Total care
                    (D)    Adaptation to physical limitations

  4.     In planning for a patient's wound care, what important measures should the nurse consider
         first?
                    (A)    Preparing supplies
                    (B)    Checking drainage tubes
                    (C)    Giving assistance to patient’s needs
                    (D)    Reducing the transfer of microorganisms

  5.     The nurse is to apply a roller bandage to a patient’s arm. The arm should be wrapped
         starting at:
                    (A)    The wrist, wrapping toward the hand
                    (B)    The wrist, wrapping toward the elbow
                    (C)    The elbow, wrapping toward the wrist
                    (D)    The fingers, wrapping toward the wrist

                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 11 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
  6.     When turning a patient with a hip prosthesis, the nurse should know to:
                    (A)    Place the patient on the affected side
                    (B)    Place the patient on the unaffected side
                    (C)    Maintain the patient's head at a 90-degree angle
                    (D)    Maintain the patient's head at a 45-degree angle

  7.     When planning care for a 90 year old patient who is ill, the nurse is aware that dehydration
         can occur when:
                    (A)    The body is unable to excrete sufficient amounts of sodium
                    (B)    There is inadequate food or fluid or fluid intake
                    (C)    The kidneys are unable to excrete wastes normally
                    (D)    The bladder is unable to hold urine

  8.     Treatment protocol and overall prognosis for a patient with pneumonia depend on the
         causative organism, which is determined by which of the following diagnostic tests?
                    (A)    X-ray examination
                    (B)    Gastric lavage
                    (C)    Blood/sputum tests
                    (D)    Bronchoscopy

  9.     A nursing colleague had a Mantoux test performed after being notified that her patient has
         an active case of tuberculosis. The nurse is aware that this test is read after:
                    (A)    24 hours
                    (B)    36 hours
                    (C)    48 hours
                    (D)    96 hours

  10.    When administering a tuberculin skin test, the nurse would insert the needle at an angle of:
                    (A)    15 degrees
                    (B)    25 degrees
                    (C)    45 degrees
                    (D)    90 degrees

  11.    The sinoatrial node is located in the:
                    (A)    Left atrium
                    (B)    Right atrium
                    (C)    Left ventricle
                    (D)    Right ventricle



                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 12 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
  12.    The diet for a patient with a diagnosis of hypertension would most likely be:
                    (A)    Bland
                    (B)    Low sodium
                    (C)    High fat
                    (D)    High cholesterol

  13.    A primary nursing goal in caring for a patient with a myocardial is to:
                    (A)    Reduce stress and anxiety level
                    (B)    Allow gradual increase in activities
                    (C)    Provide diversional activities
                    (D)    Provide complete bed rest

  14.    The nurse is to weigh a patient with congestive heart failure daily. The purpose of daily
         weigh-ins is to determine loss of:
                    (A)    Blood volume
                    (B)    Tissue fluid
                    (C)    Body fat
                    (D)    Appetite

  15.    When taking a blood pressure, the nurse is aware that the period of relaxation of the heart
         muscle is called:
                    (A)    Refractory period
                    (B)    Systole
                    (C)    Diastole
                    (D)    Atrial systole

  16.    Which of the following would be considered a secondary organ to the GI system?
                    (A)    Liver
                    (B)    Ileum
                    (C)    Stomach
                    (D)    Sigmoid Colon

  17.    A hernia in which the blood supply has been cut off is termed:
                    (A)    Incarcerated
                    (B)    Incisional
                    (C)    Strangulated
                    (D)    Umbilical




                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 13 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
  18.    The nurse should teach a patient with diabetes that early symptoms of hypoglycemia
         include:
                    (A)    Flushed face
                    (B)    Diplopia
                    (C)    Slurred speech
                    (D)    Hunger

  19.    The nurse should know that the two outstanding characteristic symptoms of diabetes
         mellitus are:
                    (A)    Hypoglycemia and glycosuria
                    (B)    Hyperglycemia and glycosuria
                    (C)    Hypoglycemia and hypokalemia
                    (D)    Hyperglycemia and glycogen

  20.    The physician has ordered an antihistamine to be given immediately to treat a patient's
         allergic reaction to an insect bite. In this situation, the emergency room nurse should expect
         which of the following drugs to be administered?
                    (A)    Ephedrine
                    (B)    Epinephrine
                    (C)    Neosynephrine
                    (D)    Hydroxyzine (Vistaril)




                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 14 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
                           LVN / LPN PHARMACOLOGY TEST
  Name:                                                                                Date:

  Please mark your answer to the following questions, print and mark the box you think is correct
  or use a mouse to click the box. Each question has only one correct answer unless otherwise
  noted.

  21.    Mr Jones temperature was 103.8 F (39 degrees C), and the Doctor ordered a drug to lower
         his temperature. Drugs of this kind are classified as:
                    (A)    Antibiotics
                    (B)    Antipyretics
                    (C)    Antiemetics
                    (D)    Antihistamines

  22.    Mrs. Smith has a diuretic ordered for congestive heart failure. The best time to administer
         this drug would be:
                    (A)    6 PM
                    (B)    1 PM
                    (C)    9 AM
                    (D)    4 PM

  23.    A Potassium retaining diuretic used to reduce hypertension and or edema is:
                    (A)    Lasix
                    (B)    Aldactone
                    (C)    Gantrisin
                    (D)    Mandelamine

  24.    A patient who is receiving heparin must be observed for the following:
                    (A)    Bleeding
                    (B)    Numbness
                    (C)    Convulsions
                    (D)    Muscle Twitching

  25.    Which of these sites is preferred for the subcutaneous administration of heparin?
                    (A)    In the deltoid muscle
                    (B)    On the top of the thigh
                    (C)    In the buttocks at a 45-degree angle
                    (D)    Below the ribs to the illac crest


                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 15 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
  26.    Insulin may be used to treat:
                    (A)    Type 1 diabetes mellitus only
                    (B)    Type 11 diabetes mellitus only
                    (C)    Type 1 and type 11 diabetes mellitus
                    (D)    Hypercalcemia

  27.    Signs of hypoglycemia include:
                    (A)    Fruity breath, thirst, flushed skin
                    (B)    Diarrhea, itching, hypertension
                    (C)    Anxiety, weakness, pallor, sweating
                    (D)    Muscle ache, fever, thirst

  28.    The name selected by the original manufacturer based on the chemical structure of the drug
         is the:
                    (A)    Chemical name
                    (B)    Generic name
                    (C)    Trade name
                    (D)    Drug name

  29.    Which is the most appropriate action for the nurse to take before administering digoxin?
                    (A)    Monitor potassium level
                    (B)    Assess blood pressure
                    (C)    Evaluate urinary output
                    (D)    Avoid giving with thiazide diruetic

  30.    Safety of a drug is determined by the degree between:
                    (A)    Therapeutic and toxic doses
                    (B)    Potency and efficacy
                    (C)    Subtherapeutic and toxic levels
                    (D)    Side and adverse effects

  31.    Which of the following clients is likely to experience adverse effects from treatment with
         diuretics?
                    (A)    21 year old client
                    (B)    40 Year old client
                    (C)    60 year old client
                    (D)    75 year old client




                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 16 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
  32.    A major side effect of insulin use that can be life threatening is:
                    (A)    Hyperglycemia
                    (B)    Stomach Upset
                    (C)    Hypoglycemia
                    (D)    Tremors

  33.    Some signs of Hypoglycemia include:
                    (A)    Fruity breath, thirst, flushed skin
                    (B)    Diarrhea, itching, hypertension
                    (C)    Anxiety, weakness, pallor, sweating
                    (D)    Muscle ache, fever, thirst

  34.    To make sure that the right client is receiving a prescribed medication, what action is
         essential for the nurse to do?
                    (A)    Check the name on the patient’s wristband
                    (B)    Call the patient by name
                    (C)    Read the name of the patient on the bed
                    (D)    Check the medication record for the patient’s room number

  35.    When preparing to give medications to the elderly the nurse knows as a general rule
         medications for elderly patients should be give in:
                    (A)    Smaller doses, closer together
                    (B)    Larger doses, closer together
                    (C)    Smaller doses, farther apart
                    (D)    Larger doses, farther apart

  36.    Which of the following actions that the nurse performs is most likely to decrease
         discomfort from an Intramuscular gluteal injection?
                    (A)    Rub skin firmly with antiseptic swab
                    (B)    Pull the skin tissue taut
                    (C)    Aspirate for blood
                    (D)    Inject the medication rapidly but consistently

  37.    The nurse on duty notices that the medications in the refrigerator are very warm and the
         temp is 80º F (26.6º C), and that the medications stored inside are all warm. The nurse
         should then:
                    (A) Notify the pharmacy and adjust the thermometer
                    (B) Close the door and report it later to the supervisor
                    (C) Adjust the temperature and recheck in an hour to be sure the temperature has
                        dropped

                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 17 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400
                    (D) Remove all of the medications and return them to the pharmacy

  38.    Mr. Bloom has an order to begin receiving penicillin. Which of the following questions
         should the nurse ask the patient before administrating the medication?
                    (A)    “Do you understand how often you will be taking this medication?”
                    (B)    “Do you have any medication allergies?”
                    (C)    ”Have you eaten recently?”
                    (D)    ”Do you know what this medication is for?”

  39.    Which of the following symptoms should concern the nurse if she observed in a patient
         after receiving a bronchodilator?
                    (A)    Fremitus
                    (B)    Wheezing
                    (C)    Rales or crackles
                    (D)    Yellow thick sputum

  40.    Before administering digoxin to a patient with congestive heart failure, the nurse will hold
         giving the medications and report to the charge nurse if:
                    (A)    Complains of nausea and vomiting and has a pulse rate of 52
                    (B)    Complains of nausea and vomiting and has a pulse rate of 80
                    (C)    Has a regular and strong pulse
                    (D)    Complains of nausea and vomiting




                               CA Correctional LVN LPN Employment Application Packet v-2 121007    Page 18 of 18
5255 Stevens Creek Blvd. #155, Santa Clara, CA 95051-6664                   Tel: 877.687.7399     Fax: 877.687.7400

				
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