ATI LPN
ATI PN Comprehensive Predictor 2020 Answers
1. How should a healthcare professional assess a patient with dehydration?
- A. Monitor skin turgor and check urine output
- B. Assess for jugular venous distention
- C. Auscultate lung sounds and monitor for fever
- D. Monitor for cyanosis and increased respiratory rate
Correct answer: A
Rationale: Correct Answer: When assessing a patient for dehydration, healthcare professionals should monitor skin turgor, as it indicates the degree of dehydration, and check urine output, as decreased urine output can be a sign of dehydration. Choices B, C, and D are incorrect because they do not directly assess for dehydration. Assessing for jugular venous distention (B) is more relevant for heart failure, auscultating lung sounds and monitoring for fever (C) are more relevant for respiratory infections, and monitoring for cyanosis and increased respiratory rate (D) are more indicative of respiratory distress rather than dehydration.
2. A nurse is preparing to administer a blood transfusion. What is the first action?
- A. Administer the blood through an IV push
- B. Verify the client's blood type before starting the transfusion
- C. Warm the blood to body temperature before administration
- D. Ensure the client eats before starting the transfusion
Correct answer: B
Rationale: The correct first action when preparing to administer a blood transfusion is to verify the client's blood type before starting the transfusion. This step is crucial to prevent transfusion reactions and complications. Option A is incorrect because blood transfusions should not be administered through an IV push due to the risk of rapid infusion and adverse reactions. Option C is incorrect because blood should be transfused at room temperature, not body temperature. Option D is incorrect because it is not necessary for the client to eat before a blood transfusion.
3. What is the recommended intervention for a patient experiencing severe hypoglycemia?
- A. Administer glucagon
- B. Provide a source of glucose
- C. Monitor blood sugar
- D. Assess vital signs
Correct answer: A
Rationale: Administering glucagon is the recommended intervention for severe hypoglycemia, especially when the patient is unconscious or unable to consume oral glucose. Glucagon helps increase blood glucose levels rapidly by stimulating the release of stored glucose from the liver. Providing a source of glucose (Choice B) can be challenging if the patient is unable to swallow or unconscious, making glucagon a more effective option. Monitoring blood sugar levels (Choice C) and assessing vital signs (Choice D) are important aspects of managing hypoglycemia but are not the immediate intervention for severe cases where prompt elevation of blood glucose levels is necessary.
4. What are the signs and symptoms of a potential infection?
- A. Fever, chills, and increased heart rate
- B. Increased white blood cell count and fever
- C. Shortness of breath and confusion
- D. Sweating and low blood pressure
Correct answer: A
Rationale: The correct answer is A: Fever, chills, and increased heart rate are classic signs of an infection. These symptoms indicate the body's response to an invading pathogen. Choice B, 'Increased white blood cell count and fever,' is not a primary symptom that a person would typically notice themselves, and white blood cell count needs to be tested. Choice C, 'Shortness of breath and confusion,' may indicate other conditions like heart or lung issues rather than a general infection. Choice D, 'Sweating and low blood pressure,' are not specific to infections and can be caused by various factors like heat or dehydration.
5. What are the key nursing interventions for a patient receiving diuretic therapy?
- A. Monitor electrolyte levels and administer potassium as needed
- B. Restrict fluid intake and provide a low-sodium diet
- C. Encourage oral fluids and increase dietary potassium
- D. Provide high-sodium foods to improve electrolyte balance
Correct answer: A
Rationale: The correct answer is A: Monitor electrolyte levels and administer potassium as needed. Patients on diuretic therapy are at risk of electrolyte imbalances, particularly low potassium levels. Monitoring electrolytes and administering potassium as needed are crucial nursing interventions to prevent imbalances. Choice B is incorrect because restricting fluid intake and providing a low-sodium diet are not typically indicated for patients on diuretic therapy. Choice C is incorrect as encouraging oral fluids and increasing dietary potassium can exacerbate electrolyte imbalances in patients on diuretics. Choice D is incorrect as providing high-sodium foods would worsen electrolyte balance issues in patients on diuretic therapy.
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