ATI LPN
ATI PN Comprehensive Predictor 2020 Answers
1. A nurse has administered medications to a group of clients. For which of the following client situations should the nurse complete an incident report?
- A. Administering acetaminophen to an NPO client
- B. Administering insulin lispro to an NPO client
- C. Administering medication to the incorrect client
- D. Administering anticoagulants without checking INR
Correct answer: B
Rationale: The correct answer is B because administering insulin lispro to an NPO client can lead to hypoglycemia due to the lack of food to balance the medication. This situation poses a serious risk to the client's safety and should be documented in an incident report. Choice A is not as critical as insulin administration for an NPO client. Choice C is also serious but does not pose an immediate risk to the client's health. Choice D, administering anticoagulants without checking the INR, is important but does not require an incident report unless adverse effects occur, as it may not immediately endanger the client's life.
2. A client with chronic obstructive pulmonary disease (COPD) is being cared for by a nurse. Which of the following interventions should the nurse include in the plan of care?
- A. Encourage pursed-lip breathing.
- B. Administer oxygen at 6 L/min via nasal cannula.
- C. Place the client in a supine position.
- D. Restrict fluid intake to less than 1,500 mL/day.
Correct answer: A
Rationale: Encouraging pursed-lip breathing is essential for clients with COPD as it aids in improving ventilation and gas exchange. This technique helps keep the airways open longer during exhalation, preventing air trapping and promoting more effective breathing. Administering oxygen, placing the client in a supine position, or restricting fluid intake are not primary interventions for managing COPD and may not address the specific respiratory needs of the client.
3. The healthcare provider is setting up the bedside unit for a client being admitted to the nursing unit from the emergency department with a diagnosis of coronary artery disease (CAD). The provider should place the highest priority on making sure that which is available at the bedside?
- A. Bedside commode
- B. Rolling shower chair
- C. Oxygen tubing and flowmeter
- D. Twelve-lead electrocardiogram (ECG) machine
Correct answer: C
Rationale: In a client with coronary artery disease (CAD), ensuring the availability of oxygen and a flowmeter at the bedside is crucial. Oxygen is essential for adequate oxygenation, which helps prevent myocardial ischemia, a common complication in CAD. The other options, such as a bedside commode and rolling shower chair, are important for patient comfort and mobility but are not as critical as ensuring proper oxygen supply in a client with CAD. While having an ECG machine available is important for ongoing monitoring, ensuring oxygen availability takes precedence in this scenario.
4. A healthcare professional is assisting with the care for a client who is experiencing a ruptured ectopic pregnancy. Which of the following findings is expected with this condition?
- A. No alteration in menses
- B. Transvaginal ultrasound indicating a fetus in the uterus
- C. Blood progesterone greater than the expected reference range
- D. Report of severe shoulder pain
Correct answer: D
Rationale: Severe shoulder pain is a common finding in clients with a ruptured ectopic pregnancy due to referred pain from diaphragmatic irritation caused by blood in the abdominal cavity. This pain is known as Kehr's sign and is often experienced in the shoulder due to irritation of the phrenic nerve. Choices A, B, and C are incorrect. A ruptured ectopic pregnancy typically presents with symptoms such as abdominal pain, vaginal bleeding, and signs of shock, rather than no alteration in menses, a fetus in the uterus, or elevated blood progesterone levels.
5. A nurse on the medical-surgical unit is receiving reports on four clients. Which of the following clients should the nurse assess first?
- A. A client who is receiving warfarin and has an INR of 3.3
- B. A client who has acute kidney injury, creatinine 4 mg/dL, and BUN 52 mg/dL
- C. A client who had an NG tube inserted 6 hours ago and has abdominal distention
- D. A client who is 4 hours postoperative following a thyroidectomy and reports fullness in the throat
Correct answer: D
Rationale: The client who is 4 hours postoperative following a thyroidectomy and reports fullness in the throat should be assessed first. This client may be experiencing airway obstruction due to hematoma or swelling, making it a priority. Options A, B, and C have concerning findings as well, but airway compromise takes precedence over other issues.
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