LPN LPN
ATI PN Comprehensive Predictor 2020 Answers
1. What is the priority intervention when managing a client with delirium?
- A. Administer antipsychotic medication to calm the client
- B. Identify any reversible causes of delirium
- C. Provide a low-stimulation environment
- D. Administer sedative medication to control agitation
Correct answer: B
Rationale: The correct answer is to identify any reversible causes of delirium. Delirium is often caused by underlying issues such as infections, medication side effects, or metabolic imbalances. Addressing these root causes can help resolve delirium more effectively. Administering antipsychotic or sedative medications should not be the initial approach as they can worsen delirium in some cases. Providing a low-stimulation environment is beneficial but not the priority when reversible causes need to be addressed first.
2. A nurse is reinforcing teaching with a client about the client's recent diagnosis of multiple sclerosis. The client states, 'I am very upset and I want to be alone for a little while.' Which of the following responses should the nurse make?
- A. I see that you are feeling overwhelmed. I will come back when you are ready
- B. This is normal, and I will check on you later
- C. You are feeling frustrated. Let's talk about your concerns.
- D. You will feel better soon. Let me get you some water.
Correct answer: A
Rationale: Acknowledging the client's feelings and allowing them space demonstrates understanding and respect for their emotions.
3. A nurse is caring for a client who has severe preeclampsia and is receiving magnesium sulfate intravenously. The nurse discontinues the magnesium sulfate after the client displays toxicity. Which of the following actions should the nurse take?
- A. Position the client supine.
- B. Prepare an IV bolus of dextrose 5% in water.
- C. Administer methylergonovine IM.
- D. Administer calcium gluconate IV.
Correct answer: D
Rationale: In cases of magnesium sulfate toxicity, calcium gluconate is the antidote that should be administered promptly. Positioning the client supine (Choice A) is not the priority in this scenario. Administering dextrose 5% in water (Choice B) is not indicated for magnesium sulfate toxicity. Methylergonovine IM (Choice C) is used for postpartum hemorrhage, not for magnesium sulfate toxicity.
4. Which of the following is an early indicator that a client with a tracheostomy may require suctioning?
- A. Decreased respiratory rate
- B. Irritability
- C. Bradycardia
- D. Decreased oxygen saturation
Correct answer: B
Rationale: Irritability is an early indicator that suctioning is necessary for a client with a tracheostomy. Irritability can signal discomfort or difficulty breathing, which may be due to the need for suctioning to clear the airway. Decreased respiratory rate, bradycardia, and decreased oxygen saturation are not typically early indicators that suctioning is needed in a client with a tracheostomy. These symptoms may occur later if the airway is not cleared promptly.
5. A public health nurse working in a rural area is developing a program to improve health for the local population. Which of the following actions should the nurse plan to take?
- A. Provide anticipatory guidance classes to parents through public schools.
- B. Have a nurse from outside the community provide health lectures at the county hospital.
- C. Encourage rural residents to focus health spending on tertiary health interventions.
- D. Launch a media campaign to increase awareness about industrial pollution.
Correct answer: A
Rationale: Providing anticipatory guidance classes to parents through public schools is the most appropriate action for the public health nurse in a rural area. This approach allows the nurse to address early prevention strategies, which are crucial in promoting health in rural populations. Choice B is incorrect because having a nurse from outside the community may not fully understand the local needs and dynamics. Choice C is wrong as focusing health spending on tertiary interventions is not cost-effective or preventive. Choice D is also incorrect because while increasing awareness about industrial pollution is important, it may not directly address the health needs of the local rural population.
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