ATI LPN
Perioperative Nursing Care NCLEX Questions Questions
Question 1 of 5
The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client?
Correct Answer: C
Rationale: For a patient transitioning to warfarin after a pulmonary embolism (PE), the nurse must clarify that anticoagulant therapy prevents new clot formation rather than dissolving existing clots, which thrombolytics might address. The typical duration for PE treatment is 3 to 6 months, depending on risk factors like provoked events (e.g., surgery), balancing prevention of recurrence against bleeding risk. Warfarin does not require aspirin (ASA) for efficacy; combining them increases bleeding risk without enhancing anticoagulation for PE. Vitamin K antagonizes warfarin's effect by promoting clotting factor synthesis, so it's contraindicated unless reversing overdose. Teaching the 3-6 month duration empowers the patient to adhere to therapy, monitor for bleeding, and follow up for INR checks, ensuring safe management of this potentially recurrent condition post-surgery.
Question 2 of 5
A patient who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this patients care?
Correct Answer: B
Rationale: Acute respiratory failure (ARF) from a penetrating chest wound likely causing pneumothorax or hemothorax disrupts ventilation and oxygenation, making restoration of adequate gas exchange the care team's priority. This goal addresses the underlying pathophysiology: air or blood in the pleural space collapses the lung, impairing oxygen uptake and CO2 elimination. Immediate interventions (e.g., chest tube, oxygen) aim to re-expand the lung and stabilize ABGs, preventing hypoxia and hypercapnia, which are life-threatening. Long-term intubation may result but isn't the initial focus resolving the cause often avoids it. Coping and self-management are secondary, relevant post-stabilization, as survival hinges on gas exchange. The nurse's role in monitoring respiratory status and supporting interventions (e.g., thoracostomy) aligns with this urgent, evidence-based priority in trauma-induced ARF.
Question 3 of 5
A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the childs nutritional status, what intervention should most likely be included in the plan of care?
Correct Answer: A
Rationale: In cystic fibrosis (CF), pancreatic enzyme supplementation with meals is essential to enhance nutritional status, as 90% of patients have exocrine pancreatic insufficiency from CFTR mutations. Thick mucus blocks pancreatic ducts, preventing digestive enzymes (e.g., lipase, protease) from reaching the gut, causing malabsorption of fats and proteins supplements (e.g., pancrelipase) correct this, improving calorie uptake critical for growth in a 6-year-old. Small, frequent meals aid digestion but don't address enzyme deficiency alone. TPN, intravenous nutrition, is reserved for severe cases, not routine CF care. Magnesium, thiamine, and iron aren't typically deficient in CF; fat-soluble vitamins (A, D, E, K) are supplemented instead due to fat malabsorption. The nurse's inclusion of enzyme therapy dosed with meals and snacks optimizes nutrition, countering CF's gastrointestinal impact, vital for this child's development.
Question 4 of 5
A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following?
Correct Answer: D
Rationale: For a COPD admission assessment, reviewing available diagnostic tests is most important, providing objective data on disease severity and guiding care. Tests like spirometry (e.g., FEV1), chest X-rays, or ABGs reveal obstruction extent, hyperinflation, or hypoxemia, informing oxygen needs, medication adjustments, or exacerbation triggers (e.g., infection). Social work assessment aids discharge planning but lacks immediate clinical priority. Insurance coverage is administrative, not affecting initial assessment. Chloride levels relate to cystic fibrosis sweat tests, not COPD's airflow limitation. The nurse's review of diagnostics e.g., a low FEV1 indicating severe obstruction ensures a tailored plan, aligning with evidence-based COPD management to address acute and chronic needs effectively.
Question 5 of 5
A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
Correct Answer: A
Rationale: In a COPD exacerbation, teaching diaphragmatic breathing best helps maintain effective oxygenation by retraining the patient's inefficient, shallow pattern. This technique abdomen expands on inhale, contracts on exhale lowers respiratory rate, boosts alveolar ventilation, and reduces air trapping from hyperinflation, improving O2 uptake. Supplementary oxygen via face mask corrects hypoxemia but doesn't address breathing mechanics, risking CO2 retention if unmonitored. Airway suctioning clears secretions, irrelevant in COPD unless pneumonia complicates it. Exercise programs aid long-term fitness but are impractical acutely due to dyspnea. The nurse's instruction hands-on, practiced optimizes oxygenation naturally, per COPD rehabilitation, empowering the patient during and post-exacerbation.