ATI LPN
ATI PN Comprehensive Predictor 2020
1. What are the principles of aseptic technique in wound care?
- A. Use sterile gloves and a clean dressing
- B. Apply a clean dressing using sterile scissors
- C. Wash hands thoroughly before applying the dressing
- D. Use a clean glove and avoid contact with the wound
Correct answer: A
Rationale: The correct answer is A: 'Use sterile gloves and a clean dressing.' Aseptic technique in wound care requires the use of sterile gloves to prevent infection. Choice B is incorrect as the method of application does not primarily focus on maintaining asepsis. Choice C, while important for infection control, is not specific to aseptic technique in wound care. Choice D is incorrect because using a single clean glove does not ensure the level of sterility needed for aseptic wound care.
2. A nurse is reviewing the medical history of a client with dementia. Which of the following findings should the nurse address first?
- A. Restlessness and agitation
- B. Decreased respiratory rate
- C. Wandering during the night
- D. Incontinence
Correct answer: A
Rationale: In a client with dementia, addressing restlessness and agitation is a priority because these symptoms can exacerbate dementia and lead to further complications. Restlessness and agitation can indicate underlying issues such as pain, discomfort, or unmet needs, which should be promptly assessed and managed to improve the client's quality of life. Decreased respiratory rate, wandering during the night, and incontinence are important to address but do not pose immediate risks to the client's well-being compared to the potential effects of unmanaged restlessness and agitation in dementia.
3. What are the nursing interventions for a patient with fluid volume overload?
- A. Restrict fluid intake
- B. Monitor intake and output
- C. Administer diuretics as prescribed
- D. Elevate the head of the bed
Correct answer: A
Rationale: The correct nursing intervention for a patient with fluid volume overload is to restrict fluid intake. This helps to prevent further fluid accumulation in the body. Monitoring intake and output (choice B) is important to assess the patient's fluid balance but is not a direct intervention to address fluid volume overload. Administering diuretics as prescribed (choice C) is a medical intervention that may be ordered by a healthcare provider but should not be assumed as a nursing intervention without a prescription. Elevating the head of the bed (choice D) is a measure commonly used for patients with respiratory distress or to prevent aspiration but is not a direct intervention for fluid volume overload.
4. What are the early signs of a pulmonary embolism?
- A. Chest pain, shortness of breath, and tachycardia
- B. Fever, nausea, and vomiting
- C. Cough, cyanosis, and fatigue
- D. Abdominal pain and bradycardia
Correct answer: A
Rationale: The correct answer is A: Chest pain, shortness of breath, and tachycardia. These are classic early signs of a pulmonary embolism. Chest pain may be sudden and sharp, worsened by deep breathing or coughing. Shortness of breath can be sudden and severe. Tachycardia (rapid heart rate) is another common symptom. Choices B, C, and D are incorrect as they do not represent typical early signs of a pulmonary embolism.
5. What are the potential complications of a patient receiving hemodialysis?
- A. Infection and hypotension
- B. Pulmonary embolism and fluid overload
- C. Blood clot formation and electrolyte imbalance
- D. Low blood pressure and nausea
Correct answer: A
Rationale: Corrected Question: What are the potential complications of a patient receiving hemodialysis? Rationale: Infection and hypotension are common complications in patients undergoing hemodialysis. Pulmonary embolism and fluid overload (Choice B) are less common complications associated with hemodialysis. Blood clot formation and electrolyte imbalance (Choice C) are also potential complications but are not as common as infection and hypotension. Low blood pressure and nausea (Choice D) can occur but are not as prevalent as infection and hypotension.
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