LPN LPN
ATI PN Comprehensive Predictor 2023 with NGN
1. Which of the following interventions should the nurse implement for a client with hyperkalemia?
- A. Administer calcium gluconate
- B. Increase fluid intake to promote potassium excretion
- C. Administer a diuretic
- D. Administer sodium bicarbonate
Correct answer: A
Rationale: The correct intervention for a client with hyperkalemia is to administer calcium gluconate. Calcium gluconate helps counteract the effects of hyperkalemia by stabilizing the cardiac cell membrane. Increasing fluid intake (Choice B) may not effectively lower potassium levels. Administering a diuretic (Choice C) or sodium bicarbonate (Choice D) is not the primary treatment for hyperkalemia and may not address the immediate need to lower potassium levels.
2. A nurse is caring for a client who has multiple fractures following a motor-vehicle crash. For which of the following client statements should the nurse recommend a referral to an occupational therapist?
- A. I can't brush my teeth properly
- B. I am so frustrated I can't open my milk carton
- C. I can't hold a pencil
- D. I can't write anymore
Correct answer: B
Rationale: The correct answer is B. The client's frustration with opening a milk carton indicates difficulty with activities of daily living, which is a common concern addressed by occupational therapists. Choices A, C, and D are related to fine motor skills, which may also be addressed by an occupational therapist but are not as directly linked to activities of daily living as struggling with tasks like opening containers.
3. A nurse is reinforcing teaching about using a cane with a client who has left-leg weakness. What instruction should the nurse give?
- A. Use the cane on the weaker side
- B. Advance the cane and the strong leg together
- C. Maintain two points of support on the floor at all times
- D. Advance the cane 30 to 45 cm with each step
Correct answer: C
Rationale: The correct instruction for a client with left-leg weakness using a cane is to maintain two points of support on the floor at all times. This technique provides stability and support while walking. Choice A is incorrect because the cane should be used on the stronger side to support the weaker leg. Choice B is incorrect as advancing the cane and the strong leg together may not provide adequate support and balance. Choice D is incorrect as the distance to advance the cane with each step can vary depending on the individual's needs and abilities.
4. What is the most appropriate strategy for a client with an NG tube who is experiencing nausea and decreased gastric secretions?
- A. Increase the suction pressure
- B. Irrigate the NG tube with sterile water
- C. Turn the client onto their side
- D. Replace the NG tube with a new one
Correct answer: B
Rationale: Irrigating the NG tube with sterile water is the most appropriate strategy for a client with an NG tube experiencing nausea and decreased gastric secretions. This intervention helps in relieving blockages within the tube and can help reduce nausea by ensuring proper drainage. Increasing the suction pressure (Choice A) can lead to complications and should not be done without healthcare provider orders. Turning the client onto their side (Choice C) is a general measure for patient comfort but does not directly address the issue with the NG tube. Replacing the NG tube with a new one (Choice D) is not necessary unless there are specific indications like tube damage or dislodgement.
5. What is the most appropriate intervention for a client with phlebitis at the IV site?
- A. Apply a warm compress to the site
- B. Discontinue the IV and notify the provider
- C. Increase the IV flow rate to prevent dehydration
- D. Monitor the site for signs of infection
Correct answer: B
Rationale: The most appropriate intervention for a client with phlebitis at the IV site is to discontinue the IV and notify the provider. Phlebitis is inflammation of the vein, and continuing the IV can lead to complications such as infection or thrombosis. Applying a warm compress may provide symptomatic relief but does not address the root cause. Increasing the IV flow rate is not indicated and may worsen the inflammation. Monitoring for signs of infection is important, but the priority is to remove the source of inflammation by discontinuing the IV.
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