ATI LPN
LPN Fundamentals Exam Questions
Question 1 of 5
The nurse identifies localized edema and __ as abnormal findings which require follow up.
Correct Answer: B
Rationale: Localized edema with pain (B) requires follow-up, indicating inflammation or injury. Ecchymosis (A) is bruising, less urgent unless severe. Rationale: Pain with edema suggests underlying issues like infection or thrombosis, needing prompt assessment per nursing triage principles.
Question 2 of 5
A client who sustained a closed head injury is being monitored for increased intracranial pressure. Arterial blood gases are obtained, and the results include a PCO2 of $33 \mathrm{~mm} \mathrm{Hg}$. What action is most important for the nurse to take?
Correct Answer: D
Rationale: A PCO2 of 33 mm Hg suggests hyperventilation, possibly compensating for ICP. Informing the provider and monitoring (D) is most important to guide management. Slowing breathing (A) risks raising PCO2. Suctioning (B) or oxygen (C) isn't indicated yet. D is correct. Rationale: Low PCO2 may reflect ICP response; ongoing monitoring and reporting ensure timely intervention, per neurocritical care standards.
Question 3 of 5
Which color of cerebrospinal fluid (CSF) may indicate subarachnoid hemorrhage in the client?
Correct Answer: B
Rationale: Yellow CSF (B) indicates subarachnoid hemorrhage due to xanthochromia from blood breakdown. Hazy (A) suggests infection. Brown (C) or colorless (D) don't fit. B is correct. Rationale: Xanthochromia confirms bleeding, a key diagnostic sign, per neurology standards, distinguishing it from other CSF changes.
Question 4 of 5
The nurse is caring for a client with a spinal cord injury at the T6 level who suddenly develops a blood pressure of 200/100 mm Hg and a headache. Which condition does the nurse suspect?
Correct Answer: B
Rationale: BP 200/100 and headache in T6 SCI suggest autonomic dysreflexia (B) from a stimulus below the injury. Neurogenic shock (A) has hypotension. Hypovolemic (C) or septic (D) don't match. B is correct. Rationale: Dysreflexia's sympathetic surge above T6 triggers hypertension, per SCI emergency care, requiring immediate stimulus removal.
Question 5 of 5
According to the nursing code of ethics, when working as a nurse and a conflict comes up between your client's needs and what the family and/or the physician wants, and/or the hospital policies, your first loyalty is to the:
Correct Answer: B
Rationale: The nursing code of ethics emphasizes that a nurse's primary loyalty is to the client, prioritizing their needs and well-being above conflicting interests from family, physicians, or hospital policies. This principle stems from the duty to advocate for the client's autonomy, safety, and health, ensuring decisions align with their best interests. When family or physician preferences diverge, the nurse must assess and support what benefits the client most, even if it means navigating tension. Hospital policies guide practice but don't override client-centered care. This ethical stance empowers nurses to act as client advocates, fostering trust and upholding professional integrity. For instance, if a family pushes for an intervention the client refuses, the nurse defends the client's right to choose, reinforcing that their needs come first in ethical practice.