ATI LPN
Medical Surgical ATI Proctored Exam
1. After undergoing rigid fixation for a mandibular fracture from a fight, what area of care should the nurse prioritize for discharge education for this client?
- A. Resumption of activities of daily living
- B. Pain control
- C. Promotion of adequate nutrition
- D. Strategies for promoting adequate nutrition
Correct answer: C
Rationale: The correct answer is promoting adequate nutrition. Following rigid fixation for a mandibular fracture, the client may have limitations in jaw movement, which can affect their ability to eat properly. Prioritizing education on promoting adequate nutrition will help ensure the client's nutritional needs are met during the recovery period.
2. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?
- A. Administer acetaminophen (Tylenol).
- B. Apply lotion to the skin.
- C. Encourage a high-protein diet.
- D. Provide a warm bath.
Correct answer: B
Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.
3. The client has undergone a thyroidectomy, and the nurse is providing care. Which assessment finding requires immediate intervention?
- A. Hoarseness and a sore throat.
- B. Difficulty swallowing.
- C. Numbness and tingling around the mouth.
- D. Temperature of 100.2°F (37.9°C).
Correct answer: C
Rationale: Numbness and tingling around the mouth can indicate hypocalcemia, a common complication post-thyroidectomy due to inadvertent parathyroid gland removal. Immediate intervention is required to prevent severe hypocalcemia manifestations like tetany or seizures. Hoarseness and a sore throat are common after a thyroidectomy due to surgical trauma and irritation to the vocal cords, not requiring immediate intervention. Difficulty swallowing can be expected due to postoperative swelling or edema, but it should be monitored closely. A temperature of 100.2°F is a mild fever and may be a normal postoperative response, not necessitating immediate intervention unless accompanied by other concerning symptoms.
4. The community health nurse is working in a multi-ethnic health center. In what situation should the nurse intervene?
- A. An Asian-American mother reports using cupping to treat an infection, resulting in a pattern of red round marks on her toddler's back.
- B. A Hispanic pregnant client who is often late for appointments arrives late for today's appointment.
- C. A Native-American individual being interviewed will not make direct eye contact when asked about violence in the home.
- D. An African-American infant who is spitting up milk has lost 6 ounces since last week's clinic visit.
Correct answer: D
Rationale: The correct answer is D because losing weight in an infant, especially when combined with spitting up milk, requires immediate intervention to address potential health concerns. Choice A deals with a cultural practice that may not necessarily pose an immediate health risk. Choice B, while important, does not present an immediate health threat. Choice C relates to cultural differences in communication and does not necessarily indicate a need for immediate intervention in terms of health.
5. The healthcare provider is assessing a client with Raynaud's phenomenon. Which finding should the healthcare provider expect?
- A. Thickened and hardened skin.
- B. Painless ulcers on the fingertips.
- C. Episodes of cyanosis and pallor in the fingers.
- D. Red, scaly patches on the hands.
Correct answer: C
Rationale: Raynaud's phenomenon is characterized by vasospasm, leading to episodes of cyanosis (bluish discoloration) and pallor (pale color) in the fingers or toes, often triggered by cold temperatures or stress. This occurs due to the reduced blood flow during vasospastic episodes, causing the discoloration. Choices A, B, and D are incorrect findings associated with other conditions and are not typical of Raynaud's phenomenon.
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