ATI LPN
ATI PN Comprehensive Predictor 2023
1. A client with an acute myocardial infarction is concerned about extreme fatigue. What is the best strategy to promote independence in self-care?
- A. Instruct the client to limit all activity until fully rested
- B. Encourage the client to gradually resume self-care tasks with rest periods
- C. Assign assistive personnel to complete self-care tasks
- D. Ask the client's family to assist with self-care
Correct answer: B
Rationale: Encouraging the client to gradually resume self-care tasks with rest periods is the best strategy to promote independence in self-care for a client with acute myocardial infarction. This approach allows the client to regain independence while considering the need for rest to prevent overexertion. Instructing the client to limit all activity until fully rested (Choice A) may hinder independence by promoting inactivity. Assigning assistive personnel to complete self-care tasks (Choice C) does not promote the client's independence. Asking the client's family to assist with self-care (Choice D) may not foster the client's self-reliance and may not always be feasible.
2. What are the signs and symptoms of hyperkalemia and how should it be managed?
- A. Muscle weakness and cardiac arrhythmias; administer calcium gluconate
- B. Confusion and bradycardia; administer insulin and glucose
- C. Fatigue and irregular heart rate; administer diuretics
- D. Nausea and vomiting; administer sodium bicarbonate
Correct answer: A
Rationale: The signs and symptoms of hyperkalemia include muscle weakness and cardiac arrhythmias, making choice A correct. Hyperkalemia can lead to dangerous cardiac effects, and calcium gluconate is used to stabilize the heart by antagonizing the effects of potassium. Choices B, C, and D describe symptoms and interventions that are not typically associated with hyperkalemia. Confusion and bradycardia are not common in hyperkalemia, and insulin and glucose are used in hyperkalemia only under specific circumstances. Fatigue and irregular heart rate are vague symptoms, and diuretics are not the primary treatment for hyperkalemia. Nausea and vomiting are nonspecific symptoms and sodium bicarbonate is not indicated for the management of hyperkalemia.
3. A nurse is caring for a client who reports burning around the peripheral IV site. Which finding should the nurse identify as a manifestation of infiltration?
- A. Redness at the site
- B. Warmth around the site
- C. Edema
- D. Pain at the site
Correct answer: C
Rationale: Edema at the IV site indicates that IV solution has leaked into the extravascular tissue, which is a sign of infiltration. Redness, warmth, and pain at the site are more indicative of phlebitis, not infiltration. Phlebitis is characterized by redness, warmth, and pain along the vein where the IV is placed, while infiltration involves the leaking of IV fluids into the surrounding tissue.
4. How can a new mother tell if her baby is getting enough breast milk?
- A. If your baby sleeps through the night, they are getting enough milk.
- B. If your baby has six to eight wet diapers a day, they are getting enough milk.
- C. If your baby cries frequently, they are getting enough milk.
- D. If your baby is awake and alert, they are getting enough milk.
Correct answer: B
Rationale: The correct answer is B. If a new mother observes that her baby has six to eight wet diapers a day, it indicates that the baby is getting enough breast milk. This is a crucial indicator of adequate milk intake and hydration in infants. Conversely, choices A, C, and D are incorrect. A baby sleeping through the night, crying frequently, or being awake and alert are not reliable indicators of sufficient breast milk intake. It is essential for new mothers to track their baby's diaper output to ensure they are receiving the necessary nutrition.
5. A client with iron-deficiency anemia is being taught about dietary management. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should increase my intake of foods high in iron.
- B. I should decrease my intake of foods high in iron.
- C. I should increase my intake of foods high in calcium.
- D. I should decrease my intake of foods high in calcium.
Correct answer: A
Rationale: The correct answer is A: 'I should increase my intake of foods high in iron.' Iron-deficiency anemia is managed by increasing the consumption of iron-rich foods to improve iron levels in the body. Foods high in iron include red meat, poultry, fish, beans, lentils, and iron-fortified cereals. Choices B, C, and D are incorrect because decreasing intake of iron-rich foods or increasing intake of calcium-rich foods would not address the deficiency in iron levels that characterizes iron-deficiency anemia.
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