ATI LPN
ATI PN Comprehensive Predictor 2020
1. A nurse is performing postmortem care for a client prior to the arrival of the client's family for viewing of the body. Which of the following actions should the nurse take?
- A. Apply moisturizing lotion to the skin
- B. Turn off the lights
- C. Remove all jewelry
- D. Gently close the client's eyelids
Correct answer: D
Rationale: The correct action the nurse should take is to gently close the client's eyelids. This is a respectful and common practice in postmortem care before allowing the family to view the body. Applying moisturizing lotion to the skin is unnecessary and may not be appropriate at this time. Turning off the lights might not be necessary and could impact the viewing environment for the family. While removing all jewelry is generally a good practice, it is not as crucial as gently closing the client's eyelids for postmortem care.
2. A nurse is teaching a client who has diabetes mellitus about foot care. Which of the following instructions should the nurse include?
- A. Soak feet in hot water daily
- B. Use a heating pad on the feet daily
- C. Cut toenails straight across
- D. Massage feet with lotion daily
Correct answer: C
Rationale: The correct answer is C: 'Cut toenails straight across.' This instruction is crucial for clients with diabetes to prevent ingrown toenails and potential foot complications. Soaking feet in hot water daily (Choice A) can lead to skin damage and is not recommended for diabetic individuals. Using a heating pad on the feet daily (Choice B) can cause burns or injuries due to reduced sensation in the feet that often accompanies diabetes. Massaging feet with lotion daily (Choice D) is generally safe but may not address the specific preventive measure of cutting toenails correctly.
3. What is the priority nursing action for a dehydrated client who needs fluids?
- A. Administer antiemetics to prevent vomiting
- B. Monitor electrolyte levels frequently
- C. Administer oral rehydration solutions
- D. Insert an NG tube for fluid administration
Correct answer: B
Rationale: The correct answer is to monitor electrolyte levels frequently. When a client is dehydrated and needs fluids, it is essential to monitor electrolyte levels to prevent complications such as electrolyte imbalances. Administering antiemetics to prevent vomiting (Choice A) may be necessary but is not the priority when addressing dehydration. Administering oral rehydration solutions (Choice C) can be beneficial, but monitoring electrolyte levels takes precedence to ensure proper hydration. Inserting an NG tube for fluid administration (Choice D) is invasive and not typically the first-line approach for managing dehydration.
4. How should a healthcare professional manage a patient with fluid overload?
- A. Restrict fluids and administer diuretics
- B. Increase fluid intake and provide oral diuretics
- C. Administer antibiotics and monitor weight
- D. Monitor weight and provide a low-sodium diet
Correct answer: A
Rationale: Corrected Question: When managing a patient with fluid overload, the appropriate approach involves restricting fluids and administering diuretics. This strategy helps remove excess fluid from the body and prevent complications associated with fluid overload. Choice B suggesting increasing fluid intake is incorrect as it would worsen the condition. Choice C, administering antibiotics, is unrelated to managing fluid overload. Choice D, monitoring weight and providing a low-sodium diet, is helpful but not as effective as fluid restriction and diuretics in managing fluid overload.
5. How should a healthcare provider manage a patient with hypertensive crisis?
- A. Administer antihypertensive medications and monitor blood pressure
- B. Provide a high-sodium diet and fluid restriction
- C. Administer diuretics and provide oxygen therapy
- D. Provide IV fluids and monitor for kidney failure
Correct answer: A
Rationale: In a hypertensive crisis, the immediate goal is to lower blood pressure to prevent organ damage. Administering antihypertensive medications helps achieve this goal efficiently. Monitoring blood pressure is essential to assess the effectiveness of the treatment and adjust medication as needed. Providing a high-sodium diet and fluid restriction (Choice B) can exacerbate hypertension by increasing blood pressure. Diuretics and oxygen therapy (Choice C) are not the first-line treatment for hypertensive crisis, as the priority is rapid blood pressure reduction. Providing IV fluids and monitoring for kidney failure (Choice D) are not primary interventions for managing hypertensive crisis; the focus is on blood pressure control and organ protection.
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