ATI LPN
LPN Fundamentals of Nursing
1. A healthcare professional is preparing to administer an intramuscular (IM) injection to a client. Which of the following actions should the healthcare professional take?
- A. Use a 1-inch needle.
- B. Insert the needle at a 45-degree angle.
- C. Aspirate before injecting the medication.
- D. Administer the injection in the deltoid muscle.
Correct answer: C
Rationale: Aspirating before injecting the medication is a crucial step in IM injections to check for blood return, ensuring that the needle is not in a blood vessel. This technique helps prevent accidental intravascular injection of the medication, reducing the risk of complications such as inadvertent intravenous administration of the substance.
2. When assessing a client with chronic pain, which of the following is the most reliable indicator of the client's pain?
- A. The client's vital signs.
- B. The client's self-report of pain.
- C. The client's body language.
- D. The client's medical history.
Correct answer: B
Rationale: The client's self-report of pain is the most reliable indicator of pain. Pain is a subjective experience, and the client's self-report provides direct insight into their perception of pain intensity, quality, and impact on daily life. Vital signs, body language, and medical history can offer additional information but may not accurately reflect the client's actual pain experience. Therefore, relying on the client's self-report ensures a more accurate assessment of their pain and helps in tailoring appropriate interventions and treatment plans.
3. During postoperative teaching following a hip arthroplasty, which instruction should the nurse include?
- A. Avoid lying on your operative side.
- B. Cross your legs at the ankles only.
- C. Place a pillow between your legs when turning.
- D. Avoid bending your hip more than 120 degrees.
Correct answer: C
Rationale: The correct instruction for the nurse to include during postoperative teaching following a hip arthroplasty is to 'Place a pillow between your legs when turning.' Placing a pillow between the legs when turning is crucial as it helps prevent dislocation of the hip prosthesis. This position aids in maintaining proper alignment and stability, thereby reducing the risk of complications after hip arthroplasty surgery. Choices A, B, and D are incorrect because they do not directly address the specific action needed to protect the hip prosthesis and prevent complications.
4. A client has a new prescription for furosemide. Which of the following instructions should the nurse include during discharge teaching?
- A. Avoid foods high in potassium.
- B. Monitor weight daily.
- C. Take the medication with food.
- D. Increase salt intake.
Correct answer: B
Rationale: Monitoring weight daily is crucial when taking furosemide to detect fluid retention or loss. Furosemide is a diuretic that helps the body get rid of excess water and salt through urine. Changes in weight can indicate fluid shifts, which could be a sign of inadequate response to the medication or worsening condition. Therefore, monitoring weight daily is essential to assess the effectiveness of furosemide therapy and detect any potential issues early on. Choices A, C, and D are incorrect. Avoiding foods high in potassium is more relevant for clients taking potassium-sparing diuretics, not furosemide. Taking furosemide with food is not necessary, as it can be taken with or without food. Increasing salt intake is contradictory to the purpose of furosemide, which aims to eliminate excess salt from the body.
5. 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.
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