ATI LPN
ATI PN Adult Medical Surgical 2019 Questions
Question 1 of 5
A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?
Correct Answer: B
Rationale: The correct answer is B: Apply lotion to the skin. Pruritus in cirrhosis is often due to dry skin. Applying lotion helps hydrate the skin, reducing itching. Acetaminophen (A) can worsen liver damage. High-protein diet (C) is not directly related to pruritus relief. Warm bath (D) may further dry the skin.
Question 2 of 5
The client has been prescribed metformin (Glucophage) for type 2 diabetes. Which instruction should the nurse include in discharge teaching?
Correct Answer: B
Rationale: The correct answer is B: Take the medication with meals. Metformin is typically taken with meals to minimize gastrointestinal side effects. Food helps in the absorption and tolerance of the medication. Taking it on an empty stomach can lead to stomach upset. Taking it at bedtime may also cause nighttime disruptions. Taking it as needed for high blood sugar is not appropriate as metformin is usually taken regularly to control blood sugar levels.
Question 3 of 5
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should the nurse monitor to determine the effectiveness of the medication?
Correct Answer: B
Rationale: The correct answer is B: Prothrombin time (PT) and international normalized ratio (INR). Warfarin works by inhibiting vitamin K-dependent clotting factors, affecting the PT and INR. Monitoring these levels helps assess the effectiveness of warfarin in preventing clot formation. Platelet count (A) assesses clotting ability but not the effectiveness of warfarin. Activated partial thromboplastin time (C) assesses intrinsic pathway clotting factors, not affected by warfarin. Fibrinogen level (D) assesses the final step of clot formation, not specific to warfarin effectiveness.
Question 4 of 5
The client has a nasogastric (NG) tube and is receiving enteral feedings. What intervention should the nurse implement to prevent complications associated with the NG tube?
Correct Answer: C
Rationale: Correct Answer: C - Keep the head of the bed elevated at 30 degrees. Rationale: 1. Elevating the head of the bed at 30 degrees helps prevent aspiration by promoting proper drainage of gastric contents. 2. This position reduces the risk of reflux and pulmonary complications in clients with NG tubes. 3. It also helps maintain the proper position of the tube in the stomach, decreasing the likelihood of displacement. Summary of Other Choices: A. Flushing the NG tube with water before and after feedings is important for tube patency but does not directly prevent complications associated with the NG tube. B. Checking gastric residual volume every 6 hours is important to monitor feeding tolerance but does not directly prevent complications related to the NG tube. D. Replacing the NG tube every 24 hours is not necessary unless there are specific indications such as tube blockage or dislodgment. Regular replacement can increase the risk of complications and is not a standard practice.
Question 5 of 5
A client with severe rheumatoid arthritis is experiencing joint pain and stiffness. Which intervention should the nurse implement to help relieve the client's symptoms?
Correct Answer: B
Rationale: The correct answer is B: Encourage passive range-of-motion exercises. This intervention helps improve joint mobility, reduce stiffness, and alleviate pain in clients with rheumatoid arthritis. Passive range-of-motion exercises can prevent joint contractures and maintain joint function. Applying cold packs (A) may help reduce inflammation but does not address joint stiffness. Administering a muscle relaxant (C) is not typically indicated for rheumatoid arthritis. Providing a high-calorie diet (D) is important for overall health but does not directly address joint pain and stiffness in this case.