ATI LPN
LPN Fundamentals of Nursing
1. A client is being discharged with a prescription for furosemide. Which of the following instructions should be included?
- A. Avoid foods high in potassium.
- B. Monitor your weight daily.
- C. Take the medication with food.
- D. Change positions slowly.
Correct answer: D
Rationale: The correct instruction to include for a client being discharged with a prescription for furosemide is to 'Change positions slowly.' Furosemide, a diuretic, can cause dizziness and orthostatic hypotension, increasing the risk of falls. By advising the client to change positions slowly, the body can adjust to postural changes gradually, reducing the likelihood of falls and related injuries.
2. A client is receiving continuous enteral feedings through a nasogastric tube. Which of the following actions should the nurse take?
- A. Elevate the head of the bed to 30°
- B. Flush the tube with 50 mL of water every 2 hours
- C. Replace the feeding bag and tubing every 72 hours
- D. Check the client's gastric residual every 8 hours
Correct answer: A
Rationale: Elevating the head of the bed to 30° is the correct action to take when a client is receiving continuous enteral feedings through a nasogastric tube. This position helps prevent aspiration of the enteral feedings into the lungs, reducing the risk of aspiration pneumonia. Additionally, elevating the head of the bed promotes proper digestion and absorption of the feedings by utilizing gravity to facilitate movement into the stomach and through the gastrointestinal tract. Flushing the tube with water every 2 hours (Choice B) is not necessary for continuous feedings and may disrupt the feeding schedule. Replacing the feeding bag and tubing every 72 hours (Choice C) is not the standard recommendation unless there are specific concerns or complications. Checking the client's gastric residual every 8 hours (Choice D) is important but not the immediate action needed to prevent aspiration during enteral feedings.
3. A client has a pressure ulcer. Which of the following findings indicates healing of the ulcer?
- A. Increase in drainage.
- B. Decrease in size.
- C. Presence of foul odor.
- D. Reddened wound edges.
Correct answer: B
Rationale: When a pressure ulcer is healing, there is a decrease in its size as the tissue repair progresses. This reduction in size is a positive indication of the healing process. An increase in drainage, presence of foul odor, or reddened wound edges are typically signs of infection or lack of improvement. Therefore, the correct answer is a decrease in size.
4. A client has a new diagnosis of hyperkalemia and is receiving teaching from a healthcare provider on dietary management. Which of the following statements should the healthcare provider include in the teaching?
- A. You should increase your intake of potassium-rich foods.
- B. You should decrease your intake of potassium-rich foods.
- C. You should avoid foods that contain lactose.
- D. You should increase your intake of dairy products.
Correct answer: B
Rationale: The correct answer is B: 'You should decrease your intake of potassium-rich foods.' Hyperkalemia is a condition characterized by excess potassium in the blood. To manage hyperkalemia effectively, it is crucial to reduce the intake of potassium-rich foods. This helps in lowering the overall potassium levels in the body and prevents complications associated with hyperkalemia. Choices A, C, and D are incorrect. Increasing the intake of potassium-rich foods (Choice A) would exacerbate hyperkalemia. Avoiding foods that contain lactose (Choice C) is not directly related to managing hyperkalemia. Increasing the intake of dairy products (Choice D) is not recommended as they can be a significant source of dietary potassium.
5. When planning to perform a sterile dressing change for a client, which of the following actions should a healthcare professional take?
- A. Wear sterile gloves to remove the old dressing.
- B. Cleanse the wound with an antiseptic solution.
- C. Use clean gloves to apply the new dressing.
- D. Open sterile supplies before donning sterile gloves.
Correct answer: D
Rationale: Opening sterile supplies before donning sterile gloves is a critical step in maintaining the sterility of the supplies during a dressing change procedure. By doing so, the healthcare professional ensures that they do not touch non-sterile surfaces with their hands once sterile gloves are worn, reducing the risk of introducing pathogens to the wound and minimizing the potential for contamination.
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