LPN LPN
ATI PN Comprehensive Predictor 2023
1. A client has a new diagnosis of Raynaud's disease. Which of the following instructions should the nurse include?
- A. Increase your intake of foods high in potassium.
- B. Keep your home environment warm.
- C. Elevate your legs when sitting.
- D. Reduce your intake of sodium.
Correct answer: B
Rationale: The correct answer is to keep the home environment warm. Raynaud's disease causes vasospasm in response to cold, so maintaining a warm environment can help prevent attacks. Choices A, C, and D are incorrect. Increasing potassium intake, elevating legs when sitting, or reducing sodium intake are not specific to managing Raynaud's disease.
2. A nurse in the emergency department is caring for a client who has full-thickness burns of the thorax and upper torso. After securing the client's airway, which of the following is the nurse's priority intervention?
- A. Providing pain management.
- B. Offering emotional support.
- C. Preventing infection.
- D. Initiating IV fluids.
Correct answer: D
Rationale: After securing the airway, initiating IV fluids is the priority to prevent hypovolemic shock in clients with severe burns. IV fluids help maintain circulating volume and prevent a drop in blood pressure due to fluid loss. Providing pain management, offering emotional support, and preventing infection are important aspects of care but are secondary to ensuring adequate fluid resuscitation in clients with severe burns.
3. How should a healthcare provider manage a patient with hyperkalemia?
- A. Administer insulin and glucose
- B. Restrict potassium intake
- C. Monitor ECG
- D. All of the above
Correct answer: D
Rationale: In managing hyperkalemia, it is essential to administer insulin and glucose to shift potassium into the cells, restrict potassium intake to prevent further elevation of serum levels, and monitor the ECG for signs of potassium-induced cardiac effects. Therefore, the correct answer is D, as all of the provided actions are important in the management of hyperkalemia. Choice A alone is not sufficient as it only addresses shifting potassium intracellularly without preventing further elevation. Choice B alone is not enough as it does not address the immediate need to lower serum potassium levels. Choice C alone is insufficient as it only monitors for cardiac effects without addressing potassium levels or shifting mechanisms.
4. What is the most appropriate action for a healthcare provider to take when a patient is experiencing a seizure?
- A. Protect the patient's head
- B. Restrain the patient's movements
- C. Insert an airway
- D. Give the patient water
Correct answer: A
Rationale: During a seizure, the most appropriate action for a healthcare provider is to protect the patient's head. This helps prevent injury, especially considering the involuntary movements and potential thrashing associated with seizures. Restraint should be avoided as it can lead to further injury or distress for the patient. Inserting an airway is not recommended during an active seizure as the patient's airway may not be obstructed, and it could pose a risk of injury. Giving the patient water during a seizure is also not advisable as there is a risk of aspiration. Therefore, the priority is to ensure the patient's safety by protecting their head.
5. A client with schizophrenia is experiencing auditory hallucinations. Which of the following actions should the nurse take?
- A. Encourage the client to lie down in a quiet room.
- B. Ask the client directly what they are hearing.
- C. Tell the client that the voices are not real.
- D. Provide headphones for the client to listen to music.
Correct answer: B
Rationale: The correct action for the nurse to take when caring for a client with schizophrenia experiencing auditory hallucinations is to ask the client directly what they are hearing. This approach helps the nurse gain insight into the client's experience, establish effective communication, and provide appropriate support. Encouraging the client to lie down in a quiet room (Choice A) may not address the hallucinations directly. Telling the client that the voices are not real (Choice C) can be invalidating and may lead to further distress. Providing headphones for music (Choice D) may not be effective in addressing the client's hallucinations.
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