LPN LPN
ATI PN Comprehensive Predictor 2020 Answers
1. A client is experiencing difficulty voiding following the removal of an indwelling catheter. What action should the nurse take to assist the client?
- A. Assess for bladder distention after 4 hours
- B. Pour warm water over the perineum
- C. Restrict the client's oral fluid intake
- D. Restrict movement for at least 12 hours
Correct answer: B
Rationale: The correct action for the nurse to assist the client who is experiencing difficulty voiding after the removal of an indwelling catheter is to pour warm water over the perineum. This technique can help stimulate urination by promoting relaxation of the perineal muscles and improving blood flow to the area. Assessing for bladder distention after 4 hours (Choice A) is important but not the immediate intervention needed to assist the client in voiding. Restricting the client's oral fluid intake (Choice C) can exacerbate the issue by reducing urine production. Restricting movement for at least 12 hours (Choice D) is unnecessary and may lead to discomfort and other complications.
2. What are common signs of hypoglycemia?
- A. Shakiness or Tremors
- B. Sweating
- C. Hunger
- D. Confusion or Irritability
Correct answer: A
Rationale: The correct signs of hypoglycemia include shakiness or tremors, sweating, and hunger. These symptoms indicate low blood sugar levels. Confusion or irritability are more associated with severe hypoglycemia, while the immediate treatment for hypoglycemia involves providing a source of glucose to raise blood sugar levels quickly.
3. A nurse is caring for a client who is taking digoxin. Which of the following findings should the nurse identify as a sign of digoxin toxicity?
- A. Bradycardia
- B. Tachycardia
- C. Hypotension
- D. Hyperkalemia
Correct answer: A
Rationale: Bradycardia is a common sign of digoxin toxicity. Digoxin, a cardiac glycoside, can lead to toxicity manifesting as bradycardia due to its effect on the heart's electrical conduction system. Tachycardia (choice B) is not typically associated with digoxin toxicity. Hypotension (choice C) and hyperkalemia (choice D) are not direct signs of digoxin toxicity. Therefore, the correct answer is bradycardia.
4. What is the best strategy for managing fatigue in a client who has had an acute myocardial infarction and is concerned about self-care?
- A. Instruct the client to rest completely and avoid all self-care tasks
- B. Encourage the client to gradually resume self-care tasks with frequent rest periods
- C. Assign assistive personnel to complete all self-care tasks
- D. Ask the client's family to assist with self-care tasks
Correct answer: B
Rationale: The best strategy for managing fatigue in a client who has had an acute myocardial infarction and is concerned about self-care is to encourage the client to gradually resume self-care tasks with frequent rest periods. This approach helps the client regain independence while managing fatigue effectively. Choice A is incorrect because complete rest without any self-care tasks may hinder recovery and independence. Choice C is not the best option as it does not promote the client's independence. Choice D, while involving family support, does not empower the client to regain self-care abilities.
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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