ATI LPN
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1. A client has hypoglycemia and is conscious. Which of the following actions should the nurse take?
- A. Administer glucagon IM
- B. Give the client 4 oz of fruit juice
- C. Provide the client with peanut butter
- D. Give the client 1 L of water
Correct answer: B
Rationale: In conscious clients with hypoglycemia, the most appropriate action is to provide a rapidly absorbed carbohydrate source like fruit juice to raise blood glucose levels quickly. Administering glucagon intramuscularly (IM) is usually reserved for unconscious clients or those who are unable to take oral glucose. Providing peanut butter or water would not rapidly address the hypoglycemic state as fruit juice would.
2. How should a healthcare professional care for a patient with a colostomy?
- A. Empty the colostomy bag regularly
- B. Provide a high-fiber diet
- C. Monitor for signs of infection
- D. Change the colostomy bag every 3 days
Correct answer: A
Rationale: Emptying the colostomy bag regularly is essential to prevent leakage and infection. By regularly emptying the bag, the risk of irritation to the skin surrounding the stoma is reduced. Providing a high-fiber diet is important for overall bowel health but is not directly related to colostomy care. While monitoring for signs of infection is crucial, the primary focus should be on proper bag emptying. Changing the colostomy bag every 3 days may not be necessary for all patients and could vary based on individual needs and the type of colostomy.
3. A healthcare provider is providing discharge teaching to a client who is recovering from acute pancreatitis. Which of the following instructions should the healthcare provider include?
- A. Consume a low-fat diet.
- B. Limit your carbohydrate intake.
- C. Increase your protein intake.
- D. Take acetaminophen for pain management.
Correct answer: A
Rationale: Clients recovering from acute pancreatitis should consume a low-fat diet to reduce the workload on the pancreas and prevent exacerbation. This diet helps in minimizing the stimulation of pancreatic enzyme secretion, which aids in the recovery process. Choices B, C, and D are incorrect as limiting carbohydrate intake or increasing protein intake may not be necessary for acute pancreatitis, and acetaminophen may not be the first-line choice for pain management in this condition.
4. A nurse is reviewing the plan of care for a client who is receiving oxygen therapy. Which of the following interventions should the nurse include to prevent complications?
- A. Check the client's oxygen saturation every 2 hours
- B. Provide humidified oxygen
- C. Instruct the client to perform deep breathing exercises
- D. Use an oxygen mask for delivery
Correct answer: B
Rationale: The correct answer is B: Provide humidified oxygen. Providing humidified oxygen helps prevent dryness and irritation of the respiratory tract during oxygen therapy. This intervention is crucial in preventing complications such as mucous membrane dryness and potential damage to the airways. Checking the client's oxygen saturation every 2 hours (choice A) is essential for monitoring the client's response to therapy but does not directly prevent complications. Instructing the client to perform deep breathing exercises (choice C) is beneficial for respiratory function but does not directly address preventing complications related to oxygen therapy. Using an oxygen mask for delivery (choice D) is a common method of administering oxygen but does not specifically focus on preventing complications like dryness and irritation.
5. A nurse is assisting with the admission of a client who has major depressive disorder. Which of the following communication techniques should the nurse use to establish a trusting relationship with the client?
- A. Offer medical advice
- B. Offer general leads
- C. Ask open-ended questions
- D. Use assertive communication
Correct answer: B
Rationale: In the context of establishing a trusting relationship with a client who has major depressive disorder, offering general leads is the most appropriate communication technique. General leads encourage clients to express themselves by providing subtle prompts or cues, which can help build rapport and trust. Offering medical advice (Choice A) is not suitable as it may come across as imposing and could hinder the establishment of trust. Asking open-ended questions (Choice C) is beneficial for eliciting detailed responses but may not be as effective at initially establishing trust as general leads. Using assertive communication (Choice D) can be perceived as aggressive and intimidating, which is not conducive to building a trusting relationship with a client who has major depressive disorder.
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