ATI LPN
ATI Adult Medical Surgical Questions
Question 1 of 5
A client is being discharged with a new prescription for enoxaparin (Lovenox). Which instruction should the nurse include?
Correct Answer: B
Rationale: The correct answer is B because expelling the air bubble from the syringe before injection helps ensure accurate dosage delivery and prevents air from being injected into the patient. Administering the injection in the thigh (A) is incorrect as enoxaparin is typically given in the abdomen. Massaging the injection site (C) can cause bruising or hematoma formation. Alternating injection sites between arms (D) is not relevant as enoxaparin is usually given in the abdomen.
Question 2 of 5
A client with peptic ulcer disease is prescribed ranitidine (Zantac). Which statement by the client indicates the need for further teaching?
Correct Answer: C
Rationale: Rationale: C is the correct answer. Ranitidine is usually taken on an empty stomach to maximize its effectiveness in reducing stomach acid production. Therefore, taking it with meals would decrease its efficacy. A, B, and D are incorrect because taking ranitidine at bedtime is common practice, smoking can worsen ulcer symptoms, and ranitidine does indeed reduce stomach acid.
Question 3 of 5
A client with chronic obstructive pulmonary disease (COPD) is receiving prednisone (Deltasone). Which side effect should the nurse monitor for?
Correct Answer: B
Rationale: The correct answer is B: Infection. Prednisone is a corticosteroid that suppresses the immune system, increasing the risk of infections in patients. The nurse should monitor for signs of infection such as fever, increased white blood cell count, and localized symptoms. Rationale: A: Hypoglycemia is not a common side effect of prednisone. Prednisone typically causes hyperglycemia. C: Hypotension is not a common side effect of prednisone. Prednisone can actually cause fluid retention and increased blood pressure. D: Weight loss is not a common side effect of prednisone. Prednisone can actually cause weight gain due to fluid retention and increased appetite.
Question 4 of 5
The nurse formulates a nursing diagnosis of 'High risk for ineffective airway clearance' for a client with myasthenia gravis. What is the most likely etiology for this nursing diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Diminished cough effort. In myasthenia gravis, muscle weakness can affect the respiratory muscles, leading to ineffective coughing and clearance of airways. Diminished cough effort can result in ineffective airway clearance, putting the client at high risk for respiratory complications. A: Pain when coughing is not the primary etiology for ineffective airway clearance in myasthenia gravis. C: Thick, dry secretions may contribute to airway clearance issues but are not the most likely etiology compared to diminished cough effort. D: Excessive inflammation is not typically associated with ineffective airway clearance in myasthenia gravis.
Question 5 of 5
When should the charge nurse intervene based on the observed behavior?
Correct Answer: B
Rationale: The correct answer is B because it violates patient confidentiality. Reading a client's history and physical in a public area breaches the client's privacy rights. The other choices do not directly compromise patient confidentiality. A involves discussing a cure for AIDS, which is not a breach of confidentiality. C involves sharing personal experiences with the client, and D involves discussing a client's history of drug abuse in a visitor's lounge, which may not be overheard by the client or staff directly involved in the client's care.