ATI LPN
LPN Fundamentals of Nursing Quizlet
1. A client has been on bed rest for 3 days. Which of the following findings should the nurse identify as an indication that the client is ready to ambulate?
- A. The client uses a walker to move from the bed to the chair.
- B. The client has a strong cough.
- C. The client can bear weight on both legs.
- D. The client has a normal respiratory rate.
Correct answer: C
Rationale: The ability to bear weight on both legs indicates muscle strength and stability necessary for ambulation. This skill is crucial for the client to support their body weight and move independently when standing or walking. Choices A, B, and D are incorrect because using a walker, having a strong cough, or having a normal respiratory rate do not directly indicate the readiness to ambulate. The key factor in determining readiness for ambulation is the client's ability to bear weight on both legs, demonstrating the necessary strength for standing and walking.
2. A client at 20 weeks of gestation is being taught by a nurse about an alpha-fetoprotein (AFP) test. Which of the following information should the nurse include?
- A. This test is used to confirm pregnancy
- B. This test is used to detect neural tube defects
- C. This test will determine the baby's lung maturity
- D. This test will check for gestational diabetes
Correct answer: B
Rationale: The correct answer is B: 'This test is used to detect neural tube defects.' An alpha-fetoprotein test is essential for screening neural tube defects in the fetus, not for confirming pregnancy, determining lung maturity, or checking for gestational diabetes. Detecting neural tube defects is crucial for early intervention and management of potential health issues in the baby.
3. While working in a long-term care facility, the nurse notices that older residents take pleasure in telling stories about their earlier lives and reliving special events. The nurse recognizes this helps residents meet which level of Maslow's Hierarchy of needs?
- A. Self-esteem
- B. Love and belonging
- C. Safety
- D. Self-actualization
Correct answer: D
Rationale: The act of telling stories and reliving special events by the older residents in the long-term care facility helps them achieve self-actualization. Self-actualization involves realizing personal potential, self-fulfillment, seeking personal growth, and reflecting on their lives and achievements, which aligns with the behavior observed by the nurse. Choices A, B, and C are incorrect because self-esteem is related to confidence and respect, love and belonging refer to social relationships and connections, and safety pertains to physical and psychological security, which are not directly addressed by the residents' behavior of storytelling and reliving special events.
4. A client is undergoing systematic desensitization for an extreme fear of elevators. Which of the following actions should be implemented with this form of therapy?
- A. Demonstrate riding in an elevator, then ask the client to imitate the behavior.
- B. Advise the client to say “stop” out loud every time they begin to feel an anxiety response related to an elevator.
- C. Gradually expose the client to an elevator while practicing relaxation techniques.
- D. Stay with the client in an elevator until the anxiety response diminishes.
Correct answer: C
Rationale: Systematic desensitization is a type of therapy used to help individuals overcome phobias or anxieties. It involves gradually exposing the client to the feared object or situation, in this case, an elevator, while simultaneously practicing relaxation techniques. This process helps the client associate relaxation with the previously feared stimulus, gradually reducing anxiety levels over time. Choice A is incorrect as it involves imitation rather than gradual exposure. Choice B is incorrect as it focuses on a verbal response rather than the systematic process of exposure and relaxation. Choice D is incorrect as it does not involve the systematic approach of gradually exposing the client while teaching relaxation techniques.
5. How can the nurse best assess that the parents demonstrate understanding of the dressing change procedure prior to discharge for their child with burns?
- A. The parents explaining the importance of using sterile technique to the nurse.
- B. The nurse observing the parents changing the dressing using appropriate technique.
- C. The parents observing the nurse changing the dressing and confirming their understanding of the procedure.
- D. The nurse allowing the parents to explain the dressing change procedure and perform it in private to boost their confidence.
Correct answer: B
Rationale: The most effective way for the nurse to assess the parents' understanding of the dressing change procedure is by observing them as they change the dressing using the correct technique. This direct observation ensures that the parents are able to perform the task correctly and confidently before discharge. Merely verbalizing or explaining the procedure may not accurately reflect the parents' competency in performing the actual task. Choice A involves the parents explaining to the nurse, which does not directly assess their practical skills. Choice C suggests the parents observing the nurse, which does not evaluate the parents' ability to perform the task independently. Choice D focuses on boosting the parents' confidence but does not directly assess their understanding and competency in performing the dressing change.
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