a client is constipated and asks the nurse for advice what should the nurse recommend

ATI LPN

ATI NCLEX PN Predictor Test

1. A client is constipated and asks the nurse for advice. What should the nurse recommend?

A. Administer a laxative to relieve discomfort
B. Increase dietary fiber to promote bowel movements
C. Advise the client to rest until symptoms resolve
D. Encourage bed rest to allow bowel function to return

Correct answer: B

Rationale: The correct recommendation for constipation is to increase dietary fiber to promote bowel movements. Dietary fiber helps add bulk to the stool, making it easier to pass and promoting regular bowel movements. Administering a laxative (Choice A) is not the first-line recommendation and should be used cautiously due to potential side effects. Resting until symptoms resolve (Choice C) and encouraging bed rest (Choice D) are not effective interventions for relieving constipation.

2. What is the correct procedure for inserting a nasogastric (NG) tube?

A. Measure the tube and insert with lubrication
B. Insert with lubrication and no measurement
C. Insert without lubrication and secure it
D. Insert with lubrication and check placement

Correct answer: A

Rationale: The correct procedure for inserting a nasogastric (NG) tube involves measuring the tube to ensure the appropriate length for insertion and using lubrication to reduce discomfort and aid in smooth insertion. Choice B is incorrect as measuring the tube is essential for proper placement. Choice C is incorrect as lubrication helps in easing the insertion process. Choice D is incorrect as checking the placement comes after insertion and should not be done simultaneously with the insertion process.

3. A nurse is caring for a client who has a prescription for metoprolol. For which of the following findings should the nurse withhold the medication?

A. Heart rate 56/min.
B. Oxygen saturation 93%.
C. Respiratory rate 18/min.
D. Blood pressure 118/74 mm Hg.

Correct answer: A

Rationale: The correct answer is A: Heart rate 56/min. Metoprolol, a beta blocker, should be withheld if the client's heart rate is below 60/min to prevent further bradycardia. Choices B, C, and D are within normal ranges and do not indicate a need to withhold metoprolol.

4. A nurse is preparing to administer enoxaparin subcutaneously to a client. Which of the following actions should the nurse take?

A. Administer the medication into the client's nondominant arm.
B. Pull the skin laterally before inserting the needle.
C. Massage the injection site after administration.
D. Pinch the skin between the thumb and forefinger.

Correct answer: D

Rationale: The correct action the nurse should take when administering enoxaparin subcutaneously is to pinch the skin between the thumb and forefinger. Pinching the skin helps to lift the subcutaneous tissue, reducing the risk of injecting into the muscle. Choices A, B, and C are incorrect. Choice A is not relevant as the injection site for enoxaparin is typically in the abdomen or thigh, not the arm. Choice B is incorrect as pulling the skin laterally is not a recommended technique for subcutaneous injections. Choice C is also incorrect as massaging the injection site after administration can increase the risk of bleeding or bruising.

5. What is the first intervention for a patient in shock?

A. Administer fluids
B. Monitor blood pressure
C. Provide oxygen
D. Call for assistance

Correct answer: A

Rationale: The correct answer is to administer fluids. In a patient experiencing shock, the priority is to address inadequate perfusion by restoring circulating blood volume. Administering fluids helps improve perfusion and oxygen delivery to vital organs. Monitoring blood pressure, providing oxygen, and calling for assistance are important steps but administering fluids is the initial and most critical intervention in the management of shock.