ATI LPN
ATI PN Comprehensive Predictor 2020
1. What is the priority intervention for sepsis?
- A. Administer IV antibiotics
- B. Monitor blood pressure
- C. Administer fluids
- D. All of the above
Correct answer: D
Rationale: In the management of sepsis, prompt intervention is crucial. Administering IV antibiotics is essential to target the underlying infection. Monitoring blood pressure helps assess the patient's hemodynamic status. Administering fluids is vital to maintain adequate perfusion. Therefore, all the options are integral components of the initial management of sepsis, making 'All of the above' the correct answer. Choosing any single intervention over the others may delay optimal care and compromise patient outcomes.
2. What action should the nurse take for a client struggling to void after having an indwelling catheter removed?
- A. Assess for bladder distention after 2 hours
- B. Encourage the client to try urinating in a sitting position
- C. Pour warm water over the client's perineum
- D. Restrict the client's fluid intake
Correct answer: C
Rationale: The correct action for the nurse to take is to pour warm water over the client's perineum. This intervention helps stimulate urination after catheter removal by providing warmth and promoting relaxation of the muscles. Assessing for bladder distention after 2 hours (Choice A) is not the initial intervention to facilitate voiding. Encouraging the client to try urinating in a sitting position (Choice B) may be uncomfortable if the client is struggling to void. Restricting the client's fluid intake (Choice D) is not appropriate as it can further exacerbate the issue by concentrating the urine.
3. A client reports difficulty having a bowel movement. What is the most appropriate intervention?
- A. Administer a laxative to relieve constipation
- B. Encourage the client to increase fiber intake
- C. Advise the client to rest in bed to avoid straining
- D. Encourage the client to exercise to stimulate bowel movement
Correct answer: B
Rationale: The correct answer is to encourage the client to increase fiber intake. Fiber helps promote regular bowel movements by adding bulk to the stool, making it easier to pass. Administering a laxative (Choice A) should not be the first-line intervention as it can lead to dependency and may not address the underlying cause of constipation. Advising the client to rest in bed (Choice C) may worsen constipation as physical activity helps stimulate bowel movements. Encouraging the client to exercise (Choice D) is beneficial, but increasing fiber intake is more directly related to improving bowel movements in this scenario.
4. A healthcare professional is reviewing the medical records of a client who has a pressure ulcer. Which of the following is an expected finding?
- A. Serum albumin level of 3 g/dL
- B. HDL level of 90 mg/dL
- C. Norton scale score of 18
- D. Braden scale score of 20
Correct answer: A
Rationale: A serum albumin level of 3 g/dL is indicative of poor nutrition, which is commonly associated with pressure ulcers. This finding suggests that the client may be at risk for developing or already has a pressure ulcer due to malnutrition. High-density lipoprotein (HDL) level of 90 mg/dL (Choice B) is not directly related to pressure ulcers. The Norton scale (Choice C) is used to assess a client's risk of developing pressure ulcers, not as a finding in a client with an existing pressure ulcer. The Braden scale (Choice D) is also a tool used to assess the risk of developing pressure ulcers, not a finding in a client with an existing pressure ulcer.
5. What are the key considerations for managing a patient with chronic obstructive pulmonary disease (COPD)?
- A. Airway Management
- B. Oxygen Therapy
- C. Smoking Cessation
- D. Pulmonary Rehabilitation
Correct answer: A
Rationale: The key considerations for managing a patient with COPD include airway management, ensuring adequate oxygenation, promoting smoking cessation, and incorporating pulmonary rehabilitation. While airway management is crucial for maintaining patency and preventing exacerbations, oxygen therapy helps improve oxygen levels in the blood. Smoking cessation is essential to slow down disease progression and reduce exacerbation risk. Pulmonary rehabilitation plays a vital role in enhancing exercise tolerance and overall quality of life for COPD patients. Therefore, while all options are important in managing COPD, airway management is the most critical aspect.
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