ATI LPN
PN ATI Capstone Maternal Newborn
1. A nurse is teaching the parents of a newborn how to care for their child's uncircumcised penis. Which of the following instructions should the nurse include?
- A. Retract the foreskin gently without force.
- B. Use a cotton swab to clean under the foreskin.
- C. Apply petroleum jelly to the foreskin.
- D. Wash the penis once a day with soap and water.
Correct answer: D
Rationale: The correct answer is to wash the penis once a day with soap and water. It is important to advise against forcefully retracting the foreskin as it can cause pain and injury. Using a cotton swab is not recommended as it can introduce foreign particles, and applying petroleum jelly is unnecessary and may lead to issues. Washing with soap and water is sufficient for hygiene without the need for additional products or manipulation of the foreskin.
2. A nurse is completing an admission assessment for a client who has hearing loss. What action should the nurse take?
- A. Speak loudly to the client
- B. Use written communication to assist with communication
- C. Avoid eye contact while speaking
- D. Use sign language without an interpreter
Correct answer: B
Rationale: The correct action for the nurse to take when assessing a client with hearing loss is to use written communication. This method helps ensure effective communication and that the client understands the information being conveyed. Speaking loudly may not be helpful and can be perceived as rude. Avoiding eye contact can hinder communication and appear disrespectful. Using sign language without an interpreter may not be appropriate if the client does not understand sign language.
3. A healthcare professional is assessing a client for signs of hypoglycemia. Which of the following findings should the healthcare professional look for?
- A. Increased thirst
- B. Fatigue
- C. Weight gain
- D. Elevated blood pressure
Correct answer: B
Rationale: The correct answer is B: Fatigue. Fatigue, along with symptoms like shakiness and irritability, are common signs of hypoglycemia. Increased thirst (Choice A) is more indicative of hyperglycemia. Weight gain (Choice C) is not typically associated with hypoglycemia. Elevated blood pressure (Choice D) is not a common sign of hypoglycemia.
4. A nurse is caring for a client who reports burning around the peripheral IV site. Which finding should the nurse identify as a manifestation of infiltration?
- A. Redness at the site
- B. Warmth around the site
- C. Edema
- D. Pain at the site
Correct answer: C
Rationale: Edema at the IV site indicates that IV solution has leaked into the extravascular tissue, which is a sign of infiltration. Redness, warmth, and pain at the site are more indicative of phlebitis, not infiltration. Phlebitis is characterized by redness, warmth, and pain along the vein where the IV is placed, while infiltration involves the leaking of IV fluids into the surrounding tissue.
5. A client is newly diagnosed with hypothyroidism and prescribed levothyroxine. Which of the following instructions should the nurse include?
- A. Take the medication with food.
- B. Take the medication in the evening.
- C. Take the medication on an empty stomach.
- D. Take the medication only when experiencing symptoms.
Correct answer: C
Rationale: The correct instruction is to take levothyroxine on an empty stomach. This is necessary for proper absorption and effectiveness of the medication. Taking it with food can interfere with absorption. Timing is also crucial; it is usually recommended to take levothyroxine in the morning to prevent potential interactions with food and other medications throughout the day. Taking the medication in the evening may lead to sleep disturbances. Lastly, waiting to take the medication only when symptoms occur is not appropriate as levothyroxine is typically taken regularly to maintain thyroid hormone levels within the body.
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