ATI LPN
LPN Fundamentals of Nursing
1. What action should the nurse take to prevent aspiration in a client receiving enteral nutrition?
- A. Flush the feeding tube with water before and after feedings.
- B. Elevate the head of the bed to 30-45 degrees during feedings.
- C. Administer the feeding slowly.
- D. Check the client's weight daily.
Correct answer: B
Rationale: Elevating the head of the bed to 30-45 degrees during feedings is essential to prevent aspiration in clients receiving enteral nutrition. This positioning helps decrease the risk of regurgitation and aspiration by supporting proper digestion and aiding food passage through the gastrointestinal tract. Elevating the head of the bed is a standard precautionary measure recommended to reduce the chances of aspiration and should be consistently implemented during feedings to ensure client safety and optimal enteral nutrition delivery.
2. A client has a new prescription for a low-fat diet. Which of the following foods should be recommended?
- A. Bacon
- B. Whole milk
- C. Chicken breast
- D. Cheese
Correct answer: C
Rationale: When following a low-fat diet, it is essential to choose foods that are low in fat. Chicken breast is a lean protein source that is low in fat, making it a suitable option for a low-fat diet. Bacon, whole milk, and cheese are higher in fat content and should be avoided or limited in a low-fat diet. Bacon is high in saturated fat, whole milk contains significant amounts of fat, including saturated fat, and cheese is also high in fat. Therefore, these options are not ideal for a low-fat diet.
3. A client has a new prescription for digoxin, and a nurse is providing teaching. Which of the following client statements indicates an understanding of the teaching?
- A. I will take my pulse before taking this medication.
- B. I will take this medication with an antacid.
- C. I will double the dose if I miss one.
- D. I will avoid eating bananas.
Correct answer: A
Rationale: The correct answer is A because taking the pulse before administering digoxin is crucial as the medication can cause bradycardia. Monitoring the pulse helps in identifying any signs of bradycardia, a common side effect of digoxin. Options B, C, and D are incorrect. Taking digoxin with an antacid may interfere with its absorption. Doubling the dose if a dose is missed can lead to overdose and adverse effects. Avoiding bananas is not specifically related to digoxin therapy.
4. A healthcare professional is preparing to administer an IM injection to a client. Which of the following techniques should the healthcare professional use to reduce discomfort?
- A. Use a 25-gauge needle.
- B. Administer the injection slowly.
- C. Massage the site after the injection.
- D. Apply ice to the injection site before administration.
Correct answer: B
Rationale: Administering the injection slowly is the recommended technique to reduce discomfort associated with IM injections. This approach allows the medication to disperse more gradually into the muscle, minimizing the sensation of pressure or pain during administration. Administering the injection slowly can also help prevent tissue damage and reduce the likelihood of injection site reactions.
5. A healthcare professional is assessing a client who has chronic pain. Which of the following findings should the healthcare professional expect?
- A. Hypotension
- B. Tachycardia
- C. Hyperthermia
- D. Depression
Correct answer: D
Rationale: The correct answer is D: Depression. Chronic pain is often associated with psychological effects like depression. Patients with chronic pain may experience feelings of hopelessness, helplessness, and despair, which are characteristic of depression. While chronic pain can lead to changes in vital signs like increased blood pressure and heart rate, hypotension, tachycardia, or hyperthermia are not typically expected findings solely due to chronic pain. Therefore, the healthcare professional should be alert to signs of depression in clients with chronic pain and address these psychological impacts appropriately.
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