ATI LPN
ATI PN Comprehensive Predictor 2020
1. Which of the following interventions should the nurse implement for a client with dementia who is at risk of falling?
- A. Keep the bed in the lowest position
- B. Raise all four side rails to prevent falls
- C. Assist with ambulation every 2 hours
- D. Use a bed exit alarm to notify staff of attempts to leave the bed
Correct answer: D
Rationale: The correct intervention for a client with dementia at risk of falling is to use a bed exit alarm to notify staff of attempts to leave the bed. This intervention helps in preventing falls by alerting the staff when the client tries to get out of bed. Keeping the bed in the lowest position (Choice A) may not prevent falls and could make it challenging for staff to provide care. Raising all four side rails (Choice B) can be a restraint and is not recommended as it may lead to entrapment or other risks. Assisting with ambulation every 2 hours (Choice C) may not be feasible or effective in preventing falls, as the client may attempt to get out of bed at any time.
2. A healthcare provider is assessing a client who has received a preoperative dose of morphine. Which of the following findings is the priority to report to the provider?
- A. Client reports nausea.
- B. Urinary output of 20 mL/hr.
- C. Oxygen saturation 90%.
- D. Respiratory rate 14/min.
Correct answer: C
Rationale: An oxygen saturation of 90% is below the expected reference range and could indicate respiratory depression, a serious side effect of morphine. This finding requires immediate attention as it may lead to hypoxia. Nausea (choice A) is a common side effect of morphine but does not pose an immediate threat. A urinary output of 20 mL/hr (choice B) may indicate decreased renal perfusion but is not as critical as respiratory compromise. A respiratory rate of 14/min (choice D) is within the normal range and does not suggest immediate danger.
3. A high blood cholesterol level appears to be associated with the development of:
- A. chronic kidney disease.
- B. coronary heart disease.
- C. Alzheimer’s disease.
- D. Addison’s disease.
Correct answer: B
Rationale: A high blood cholesterol level is associated with an increased risk of developing coronary heart disease. Elevated cholesterol levels can lead to the buildup of plaque in the arteries, increasing the risk of heart disease. Choices A, C, and D are incorrect as high blood cholesterol is not primarily linked to chronic kidney disease, Alzheimer’s disease, or Addison’s disease.
4. To prevent diarrhea in children, a vaccine is available against which of the following?
- A. Adenovirus
- B. Rotavirus
- C. Enterovirus
- D. All of the above
Correct answer: B
Rationale: The correct answer is B - Rotavirus. Rotavirus vaccine is available to prevent diarrhea in children. Rotavirus is a common cause of severe diarrhea in infants and young children globally, and vaccination has been shown to be effective in reducing the burden of this disease. Choices A and C are incorrect because there is no specific vaccine available for Adenovirus or Enterovirus to prevent diarrhea in children. Choice D is incorrect because while vaccines are available for some viruses that can cause diarrhea in children, not all mentioned in the choices have a specific vaccine available.
5. A nurse is caring for a client receiving radiation treatments for cancer. The client states he is experiencing dryness, redness, and scaling at the treatment area. Which of the following should the nurse instruct the client to do?
- A. Sit in the sun for 15 minutes per day.
- B. Apply moist heat to the area twice daily.
- C. Liberally apply prescribed lotion to the area.
- D. Wash the affected area daily with antimicrobial soap.
Correct answer: C
Rationale: The nurse should instruct the client to liberally apply prescribed lotion to the treatment area. Prescribed hydrating lotions help soothe and protect irradiated skin, reducing dryness, redness, and scaling. Sitting in the sun can further damage the skin. Applying moist heat may exacerbate the skin condition. Washing the area with antimicrobial soap can be too harsh and further irritate the skin.
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