ATI LPN
LPN Fundamentals of Nursing
1. What action should the healthcare provider take for a patient with a chest tube?
- A. Strip the drainage tubing every 4 hours.
- B. Keep the drainage system below the level of the patient's chest.
- C. Clamp the chest tube when ambulating the patient.
- D. Ensure the water seal chamber is filled to the prescribed level.
Correct answer: D
Rationale: Ensuring the water seal chamber is filled to the prescribed level is essential for the chest tube's effective functioning. This maintains the integrity of the system, prevents air from entering the pleural space, and facilitates proper drainage. Stripping the drainage tubing, keeping the drainage system below the chest level, or clamping the chest tube during ambulation are not recommended practices and can lead to complications.
2. What is a true statement about caring for a client with a nasogastric (NG) tube?
- A. The NG tube should be flushed with 30 mL of water every 4 hours.
- B. The client should be positioned in a supine position.
- C. The NG tube should be advanced 5 cm if resistance is met.
- D. The client's nasal mucosa should be inspected daily.
Correct answer: A
Rationale: Flushing the NG tube with 30 mL of water every 4 hours is crucial to maintain its patency and prevent blockages. This routine ensures the tube stays clear and functional, enabling proper delivery of medications and nutrition to the client. Regular flushing also helps prevent residue buildup or clogs within the tube, reducing risks like aspiration or inaccurate medication dosing.
3. Which of the following techniques should be used to insert an indwelling urinary catheter for a female client?
- A. Use sterile technique.
- B. Insert the catheter 2-3 inches into the urethra.
- C. Inflate the balloon after insertion.
- D. Lubricate the catheter tip before insertion.
Correct answer: D
Rationale: Lubricating the catheter tip before insertion is crucial for female urinary catheterization. This step helps reduce discomfort for the patient and facilitates smooth catheter insertion into the urethra. Using sterile technique maintains asepsis during the procedure, inserting the catheter 2-3 inches ensures proper placement, and inflating the balloon after insertion secures the catheter in place without causing trauma. Proper technique is fundamental for patient comfort, preventing infection, and ensuring the success of the catheterization procedure.
4. A healthcare provider is preparing to administer an intramuscular injection to an adult client. Which of the following injection sites should the healthcare provider select?
- A. Deltoid muscle
- B. Dorsogluteal muscle
- C. Vastus lateralis muscle
- D. Rectus femoris muscle
Correct answer: A
Rationale: The deltoid muscle is a common site for intramuscular injections in adults due to its accessibility and muscle mass. It is located in the upper arm and provides a sufficient area for injection. The deltoid muscle is preferred for administering vaccines and other medications that require IM administration. Choice B, the dorsogluteal muscle, is not recommended for intramuscular injections due to the proximity of major nerves and blood vessels in that area, which can lead to nerve damage or injury. Choice C, the vastus lateralis muscle, is more commonly used for infants and young children, while choice D, the rectus femoris muscle, is not typically used for intramuscular injections in adults.
5. A client has a prescription for a clear liquid diet. Which of the following foods should the nurse offer?
- A. Milk
- B. Vegetable juice
- C. Chicken broth
- D. Orange juice with pulp
Correct answer: C
Rationale: A clear liquid diet consists of easily digestible transparent liquids. Chicken broth is an appropriate choice as it meets the criteria of being clear and liquid, making it suitable for a clear liquid diet. Milk, vegetable juice, and orange juice with pulp are not considered clear liquids. Milk is not transparent, vegetable juice is not clear, and orange juice with pulp contains solid particles, all of which do not align with the requirements of a clear liquid diet.
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