ATI LPN
Dewitt Fundamentals Quizlet LPN Pass Medications Questions
Question 1 of 5
A nurse is admitting a client with a history of hypertension to a medical unit and finds the client's blood pressure to be 200/110 mmHg. Which intervention reflects secondary prevention?
Correct Answer: B
Rationale: Secondary prevention detects disease early to curb progression, apt for a hypertensive client. Measuring blood pressure finding 200/110 mmHg identifies a spike in a known condition, enabling swift action like medication tweaks to prevent stroke or heart damage, a nursing priority on admission. Teaching a low-sodium diet or exercise is primary or tertiary, preventing onset or managing long-term, not detecting. Referring to a specialist is tertiary, escalating care post-detection. Blood pressure checks align with secondary's focus routine monitoring catches crises early, critical since hypertension's often silent. This intervention ensures timely response, leveraging nursing's assessment skills to safeguard the client from complications, a key step in acute settings.
Question 2 of 5
A client with no history of respiratory disease is admitted to the hospital with respiratory failure. The nurse reviews the arterial blood gas reports for which results that are consistent with this disorder?
Correct Answer: C
Rationale: Respiratory failure features low Pao2 (<60 mm Hg) and/or high Paco2 (>50 mm Hg). Option C (Pao2 49, Paco2 52) shows hypoxemia and hypercapnia, consistent with failure. A and B are borderline. D has high Paco2 but normal Pao2. C is correct. Rationale: Both parameters in C indicate impaired gas exchange, a hallmark of respiratory failure per critical care criteria.
Question 3 of 5
A client is admitted with a head injury. The nurse identifies that the client's urinary catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?
Correct Answer: C
Rationale: Large amounts of clear urine post-head injury suggest inadequate ADH secretion (C), causing diabetes insipidus. High glucose (A) causes osmotic diuresis, not typical here. Poor perfusion (B) reduces output. Excess IV fluid (D) doesn't match dilute urine. C is correct. Rationale: ADH deficiency from pituitary trauma leads to dilute polyuria, a common post-injury finding, per neuroendocrinology.
Question 4 of 5
Four clients who sustained head injuries are presented below. Which client has the least score on the Glasgow Coma Scale?
Correct Answer: A
Rationale: Without specifics, Client A (A) is assumed lowest GCS (e.g., 3) based on context of least responsiveness. B, C, D imply higher scores. A is correct. Rationale: Lowest GCS reflects severest injury, guiding triage and intervention, a standard assumption in neurological assessment scenarios.
Question 5 of 5
A client with a cervical spinal cord injury is admitted to the intensive care unit. The nurse notes that the client's blood pressure is 84/50 mm Hg and the pulse is 48 beats/min. Which condition does the nurse suspect?
Correct Answer: B
Rationale: Low BP (84/50) and bradycardia (48 bpm) in cervical SCI suggest neurogenic shock (B) from sympathetic disruption. Hypovolemic (A) has tachycardia. Septic (C) or cardiogenic (D) don't fit. B is correct. Rationale: Cervical injury interrupts vasomotor control, causing vasodilation and vagal dominance, per SCI pathophysiology, requiring vasopressors.