ATI LPN
LPN Fundamentals of Nursing
1. When teaching a client how to perform self-catheterization, which of the following instructions should be included?
- A. Use sterile gloves during the procedure.
- B. Clean the catheter with alcohol after each use.
- C. Insert the catheter 2-4 inches into the urethra.
- D. Perform the procedure every 8 hours.
Correct answer: C
Rationale: To ensure effective drainage, the catheter should be inserted 2-4 inches into the urethra. This length allows the catheter to reach the bladder, bypass the urethral sphincters, and ensure proper drainage without causing discomfort or injury. Using sterile gloves, cleaning the catheter with alcohol, and performing the procedure every 8 hours are not accurate instructions for self-catheterization.
2. When teaching a client with a new diagnosis of hepatitis about dietary management, which of the following statements should the nurse include?
- A. Increase your intake of high-protein foods.
- B. Decrease your intake of high-protein foods.
- C. Avoid foods that contain lactose.
- D. Increase your intake of dairy products.
Correct answer: B
Rationale: For a client with hepatitis, it is important to decrease the intake of high-protein foods. High-protein foods can be harder for the liver to process and may exacerbate symptoms or contribute to liver damage. Recommending a diet with moderate protein intake is beneficial for managing symptoms and promoting liver health. Choice A is incorrect as increasing high-protein foods can strain the liver. Choice C is not directly related to hepatitis unless there is an intolerance present. Choice D is also incorrect because increasing dairy products may not be suitable for all individuals with hepatitis, especially if there are underlying liver conditions that could be aggravated by certain dairy components.
3. When caring for a client with a hearing impairment, which of the following actions should the nurse take when speaking with the client?
- A. Speak in a high-pitched voice.
- B. Exaggerate lip movements.
- C. Face the client when speaking.
- D. Use a monotone voice.
Correct answer: C
Rationale: When caring for a client with a hearing impairment, it is essential for the nurse to face the client when speaking. By facing the client, the nurse allows the individual to read lips and see facial expressions, which can significantly improve communication effectiveness. This approach facilitates better understanding and helps the client feel more connected during interactions. Speaking in a high-pitched voice (Choice A) is not recommended as it may distort speech sounds. Exaggerating lip movements (Choice B) can be patronizing and ineffective. Using a monotone voice (Choice D) lacks intonation that helps convey meaning and emotions in speech, making it harder for the client to understand.
4. When planning care for a client with a pressure ulcer, which intervention should the nurse include in the plan?
- A. Massage the reddened area.
- B. Apply a donut-shaped cushion.
- C. Reposition the client every 3 hours.
- D. Use a transparent film dressing.
Correct answer: D
Rationale: The correct intervention for a client with a pressure ulcer is to use a transparent film dressing. This dressing provides a protective barrier against external contaminants while allowing for wound inspection, promoting healing. Massaging the reddened area can cause further damage to the skin and should be avoided. Donut-shaped cushions can increase pressure on the ulcer site rather than alleviate it. Repositioning the client every 2 hours is a preventive measure for pressure ulcers, but once an ulcer has developed, using a transparent film dressing is a more appropriate intervention to facilitate healing and protect the wound site.
5. A client with celiac disease is being taught about dietary management. Which statement by the client indicates an understanding of the teaching?
- A. I should avoid foods that contain gluten.
- B. I should increase my intake of foods high in gluten.
- C. I should avoid foods that contain lactose.
- D. I should increase my intake of foods high in lactose.
Correct answer: A
Rationale: The correct answer is A: 'I should avoid foods that contain gluten.' Celiac disease requires the avoidance of gluten-containing foods to manage symptoms and prevent complications. Gluten is found in wheat, barley, and rye. Choices B, C, and D are incorrect as they do not align with the dietary requirements for managing celiac disease. Increasing intake of foods high in gluten or lactose would be detrimental for someone with celiac disease.
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