LPN LPN
ATI PN Comprehensive Predictor 2020 Answers
1. A nurse is caring for a client who has been experiencing chronic pain. Which of the following interventions should the nurse implement?
- A. Provide the client with distractions such as television
- B. Administer pain medication around the clock
- C. Teach the client relaxation techniques
- D. Perform massage therapy on the client
Correct answer: C
Rationale: The correct intervention for a client experiencing chronic pain is to teach relaxation techniques. This helps the client manage pain more effectively by reducing stress and anxiety, which can contribute to the perception of pain. Providing distractions like television (Choice A) may offer temporary relief but does not address the underlying issue of chronic pain. Administering pain medication around the clock (Choice B) may lead to dependency and not promote holistic pain management. Massage therapy (Choice D) can be beneficial but may not be as effective as teaching relaxation techniques in the long term for managing chronic pain.
2. What are the key components of a focused respiratory assessment, and how do you recognize signs of respiratory distress?
- A. Inspection, Palpation, Percussion, Auscultation
- B. Palpation, Inspection, Observation, Auscultation
- C. Percussion, Inspection, Auscultation, Palpation
- D. Inspection, Percussion, Auscultation, Palpation
Correct answer: A
Rationale: The correct answer is A: Inspection, Palpation, Percussion, Auscultation. A focused respiratory assessment should start with inspection (observing the breathing pattern), followed by palpation (feeling for abnormalities like crepitus), percussion (evaluating for dullness or hyperresonance), and auscultation (listening to lung sounds). This systematic approach helps to identify signs of respiratory distress, such as abnormal breath sounds, increased respiratory rate, use of accessory muscles, and cyanosis. Choices B, C, and D are incorrect because they do not follow the standard order and sequence of a focused respiratory assessment.
3. A client is prescribed simvastatin. Which instruction should the nurse provide during teaching?
- A. Take this medication in the morning.
- B. Avoid drinking grapefruit juice.
- C. Increase your intake of leafy green vegetables.
- D. Monitor your pulse daily while taking this medication.
Correct answer: B
Rationale: The correct answer is B: 'Avoid drinking grapefruit juice.' Grapefruit juice can increase the risk of toxicity when taken with simvastatin. Instructing the client to avoid grapefruit juice helps prevent this interaction. Choice A is incorrect because the timing of medication administration for simvastatin is usually in the evening. Choice C is unrelated to simvastatin therapy. Choice D is not necessary for monitoring while taking simvastatin.
4. A client with left-leg weakness is learning to use a cane. Which teaching point is most appropriate?
- A. Use the cane on the weaker side of the body
- B. Maintain two points of support on the ground at all times
- C. Advance the cane 30 to 45 cm with each step
- D. Advance the cane and the strong leg simultaneously
Correct answer: B
Rationale: The correct teaching point is to maintain two points of support on the ground at all times when using a cane. This ensures stability and helps distribute weight evenly. Choice A is incorrect because the cane should be used on the stronger side of the body to provide support to the weaker leg. Choice C is incorrect as advancing the cane too far with each step can lead to imbalance. Choice D is incorrect as advancing the cane and the strong leg simultaneously may not provide adequate support for the weaker leg.
5. A nurse is caring for a client who has dementia. Which of the following interventions should the nurse take to minimize the risk of injury for this client?
- A. Use a bed exit alarm system
- B. Raise all four side rails while the client is in bed
- C. Apply one soft wrist restraint
- D. Dim the lights in the client's room
Correct answer: A
Rationale: Using a bed exit alarm system is crucial in minimizing the risk of injury for a client with dementia. This intervention helps alert staff when the client is attempting to leave the bed, reducing the chances of falls. Raising all four side rails while the client is in bed (Choice B) can lead to restraint-related issues and is not recommended unless necessary for safety reasons. Applying a soft wrist restraint (Choice C) is generally not the first choice in managing clients with dementia due to the risk of complications and loss of mobility. Dimming the lights in the client's room (Choice D) may not directly address the risk of injury associated with dementia and may even increase the risk of falls due to poor visibility.
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