ATI LPN
LPN Fundamentals of Nursing
1. A client with a new diagnosis of diabetes mellitus is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will take my insulin only if my blood sugar is above 200 mg/dL.
- B. I will eat a snack before exercising.
- C. I will avoid all carbohydrates.
- D. I will check my blood sugar once a week.
Correct answer: B
Rationale: Eating a snack before exercising is crucial for managing blood sugar levels and preventing hypoglycemia in individuals with diabetes. Exercising on an empty stomach can lead to low blood sugar levels, but consuming a snack before physical activity helps stabilize blood sugar and provides energy for the body. This proactive approach demonstrates the client's understanding of the importance of managing blood sugar levels during physical activity.
2. What action should a healthcare provider take for a client with a new colostomy?
- A. Empty the colostomy bag when it is half full.
- B. Place aspirin in the colostomy bag to decrease odor.
- C. Use sterile technique when caring for the stoma.
- D. Change the pouch every 8 hours.
Correct answer: A
Rationale: Emptying the colostomy bag when it is half full is crucial to prevent leakage and detachment from the skin. This practice helps to maintain the integrity of the colostomy system, reducing the risk of skin irritation and odor. It is essential for client comfort and overall stoma care.
3. A client has a stage 1 pressure ulcer on the right heel. Which of the following interventions should the nurse include in the plan?
- A. Apply a heat lamp to the area for 20 minutes each day.
- B. Change the dressing on the heel every 12 hours.
- C. Apply a transparent dressing over the heel.
- D. Use a water pressure mattress.
Correct answer: C
Rationale: Applying a transparent dressing over the heel is beneficial as it can protect the ulcer from friction and shear, and allow for continuous observation of the wound. This intervention promotes healing and prevents further damage to the skin. Choice A is incorrect because applying heat can increase the risk of tissue damage and should be avoided. Choice B is incorrect as changing the dressing every 12 hours may disrupt the wound healing process and is not necessary for a stage 1 pressure ulcer. Choice D is incorrect because using a water pressure mattress is not a specific intervention for a stage 1 pressure ulcer on the heel.
4. A healthcare provider is providing teaching to a client regarding protein intake. Which of the following foods should the healthcare provider include as an example of an incomplete protein?
- A. Eggs
- B. Soybeans
- C. Lentils
- D. Yogurt
Correct answer: C
Rationale: The correct answer is C: Lentils. Incomplete proteins lack one or more essential amino acids required for protein synthesis in the body. Examples of incomplete proteins include lentils, vegetables, grains, nuts, and seeds. Lentils, a plant-based protein source, are considered incomplete as they do not contain all essential amino acids in sufficient amounts. Choices A, B, and D are incorrect as eggs, soybeans, and yogurt are examples of complete proteins, containing all essential amino acids in the right proportions for the body's needs.
5. When preparing to insert an NG tube for a client who requires gastric decompression, which of the following actions should the nurse take?
- A. Position the client with the head of the bed elevated to 30° prior to insertion
- B. Measure the tube from the client's nose to the earlobe to the xiphoid process
- C. Lubricate the entire length of the tube with water-soluble lubricant
- D. Instruct the client to cough during insertion
Correct answer: B
Rationale: Measuring the tube from the client's nose to the earlobe to the xiphoid process ensures the tube is inserted to the correct depth. This measurement helps prevent complications such as tube misplacement or lung insertion. Positioning the client with the head of the bed elevated to 30° is important to facilitate easier insertion but is not the most crucial step. Lubricating the entire length of the tube with water-soluble lubricant is essential for smooth insertion but is not the most critical action. Instructing the client to cough during insertion is not necessary and may lead to unnecessary discomfort.
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