ATI LPN
ATI PN Comprehensive Predictor 2020
1. A nurse is caring for a client who has a chest tube following a thoracotomy. Which of the following findings should the nurse report to the provider?
- A. Drainage of 75 mL in the first hour after surgery.
- B. Constant bubbling in the water seal chamber.
- C. Tidaling in the water seal chamber.
- D. Client report of pain at the chest tube insertion site.
Correct answer: B
Rationale: Constant bubbling in the water seal chamber indicates an air leak, which should be reported to the provider. This finding suggests that the chest tube system is not functioning properly, leading to potential complications such as pneumothorax. Drainage of 75 mL in the first hour after surgery is within the expected range for a chest tube. Tidaling in the water seal chamber is a normal fluctuation and indicates proper functioning of the system. Client report of pain at the chest tube insertion site is expected after surgery and can be managed with appropriate pain management measures.
2. What are the nursing interventions for a patient experiencing hypoglycemia?
- A. Administer glucose or dextrose and monitor blood sugar levels
- B. Monitor vital signs and provide a high-carbohydrate snack
- C. Monitor for sweating and confusion
- D. Provide insulin and assess for hyperglycemia
Correct answer: A
Rationale: The correct answer is A. Administering glucose or dextrose is a crucial nursing intervention for a patient experiencing hypoglycemia as it helps to quickly raise blood sugar levels. Monitoring blood sugar levels is essential to ensure that the patient's glucose levels normalize. Choice B is incorrect because providing a high-carbohydrate snack may not be sufficient to rapidly raise blood sugar levels in severe hypoglycemia. Choice C is incorrect because while monitoring for sweating and confusion is important in hypoglycemia, it is not a direct nursing intervention. Choice D is incorrect as providing insulin would lower blood sugar levels further, worsening hypoglycemia.
3. A nurse is caring for a client who has dementia. Which of the following interventions should the nurse take to minimize the risk for injury for this client?
- A. Use a bed exit alarm system
- B. Raise all four side rails while the client is in bed
- C. Apply soft wrist restraints
- D. Dim the lights in the client's room
Correct answer: A
Rationale: The correct answer is A: Using a bed exit alarm system. A bed exit alarm alerts staff when a client with dementia attempts to leave the bed, reducing the risk of falls. Choice B is incorrect because raising all four side rails can lead to restraint-related injuries and is not recommended. Choice C is incorrect as applying wrist restraints should be avoided due to the risk of injury and decreased mobility. Choice D is incorrect as dimming the lights in the client's room does not directly address the risk of injury associated with dementia.
4. What is the most appropriate nursing diagnosis for a patient with agoraphobia who reports not having left their house in months?
- A. Social isolation
- B. Ineffective coping
- C. Risk for injury
- D. Impaired social interaction
Correct answer: A
Rationale: The nursing diagnosis 'Social isolation' is most appropriate for a patient with agoraphobia who has not left their house in months. Agoraphobia often leads to the avoidance of situations or places perceived as unsafe, resulting in social isolation. This diagnosis reflects the patient's limited social interactions and confinement to the home environment, which can impact their overall well-being and mental health. The other options are not as relevant in this scenario: 'Ineffective coping' does not directly address the social withdrawal aspect, 'Risk for injury' is not the primary concern presented, and 'Impaired social interaction' does not capture the extent of isolation described.
5. A patient with obsessive-compulsive disorder (OCD) is prescribed fluvoxamine. What is a common side effect of this medication?
- A. Increased appetite
- B. Dry mouth
- C. Weight gain
- D. Nausea
Correct answer: D
Rationale: Nausea is a common side effect of fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of OCD. Patients should be advised to monitor and report any gastrointestinal disturbances, including nausea, to their healthcare provider.
Similar Questions
Access More Features
ATI Basic
- 50,000 Questions with answers
- All ATI courses Coverage
- 30 days access @ $69.99
ATI Basic
- 50,000 Questions with answers
- All ATI courses Coverage
- 90 days access @ $149.99