ATI LPN
ATI PN Comprehensive Predictor 2020
1. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?
- A. Monitor the client's temperature every 4 hours
- B. Monitor blood glucose levels every 6 hours
- C. Administer insulin as prescribed
- D. Monitor daily fluid intake
Correct answer: B
Rationale: Corrected Rationale: Monitoring blood glucose levels is crucial in clients receiving TPN because the solution has a high glucose content. This monitoring helps prevent hyperglycemia and allows for timely adjustments in the TPN formulation if needed. Monitoring the client's temperature (Choice A) is not directly related to TPN administration. Administering insulin (Choice C) should be based on blood glucose levels and the healthcare provider's orders; it is not a standard intervention for all clients on TPN. Monitoring daily fluid intake (Choice D) is important for overall fluid balance but is not as critical as monitoring blood glucose levels specifically for clients on TPN.
2. When receiving change-of-shift report for a group of clients, which time-management strategy should the nurse plan to implement?
- A. Prepare a priority list of client needs for the shift
- B. Complete less time-consuming tasks first
- C. Handle urgent client needs at the end of the shift
- D. Work on each client as they are seen
Correct answer: A
Rationale: Preparing a priority list of client needs for the shift is the most effective time-management strategy for a nurse receiving change-of-shift report. This approach helps the nurse identify and address the most urgent client needs first, ensuring efficient use of time. Choice B is incorrect because focusing on less time-consuming tasks first may result in crucial tasks being delayed. Choice C is incorrect as urgent client needs should be handled promptly, not postponed until the end of the shift. Choice D is inefficient as it does not prioritize tasks based on urgency, potentially leading to delays in addressing critical client needs.
3. A client receiving chemotherapy has developed stomatitis. Which of the following interventions should the nurse implement?
- A. Provide lemon-glycerin swabs
- B. Encourage the client to eat soft foods
- C. Avoid using toothpaste
- D. Instruct the client to use a mouthwash containing alcohol
Correct answer: B
Rationale: The correct intervention for a client with stomatitis is to encourage them to eat soft foods. Soft foods help prevent further irritation of the mouth, making it easier for the client to eat and reducing discomfort. Providing lemon-glycerin swabs could be too harsh on the already irritated mucosa. Avoiding toothpaste is relevant for clients with stomatitis to prevent further irritation. Instructing the client to use a mouthwash containing alcohol is contraindicated as alcohol can further irritate the mucosa.
4. A client with COPD is being cared for by a nurse. Which of the following interventions should the nurse include in the plan of care?
- A. Administer oxygen at 2 L/min via nasal cannula
- B. Encourage pursed-lip breathing
- C. Position the client in high Fowler's position
- D. Encourage deep breathing and coughing
Correct answer: B
Rationale: The correct intervention for a client with COPD is to encourage pursed-lip breathing. Pursed-lip breathing helps maintain airway patency by preventing the collapse of small airways during exhalation, improving breathing efficiency. Administering oxygen at 2 L/min via nasal cannula may be appropriate for some COPD patients but is not the priority intervention. Positioning the client in high Fowler's position may help improve breathing but is not as specific as pursed-lip breathing for COPD. Encouraging deep breathing and coughing may be beneficial in other respiratory conditions, but it is not the most effective intervention for COPD.
5. A healthcare professional is managing a client with a wound infection. What is the priority action?
- A. Change the wound dressing every 12 hours
- B. Perform a wound culture before applying antibiotics
- C. Apply a wet-to-dry dressing to the wound
- D. Cleanse the wound with a solution of alcohol and water
Correct answer: B
Rationale: Performing a wound culture before applying antibiotics is crucial to identify the specific pathogen causing the infection. This helps in selecting the most effective antibiotics for treatment. Changing the wound dressing, applying a wet-to-dry dressing, or cleansing the wound are important interventions but should follow the assessment and identification of the infecting organism through a wound culture to guide appropriate treatment.
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