ATI LPN
LPN Fundamentals Study Guide Questions
Question 1 of 5
What action should the nurse take when caring for a client who has a possible skull fracture as a result of trauma?
Correct Answer: A
Rationale: For a possible skull fracture, monitoring for brain injury signs (A) is the priority, detecting neurological deterioration like altered consciousness or pupil changes. Checking hemorrhage (B) is secondary. Elevating the foot (C) risks increasing ICP. Observing decreased ICP (D) is incorrect; increased ICP is the concern. A is correct. Rationale: Brain injury monitoring identifies life-threatening complications like hematoma, guiding timely intervention, per trauma care protocols, over less immediate or contraindicated actions.
Question 2 of 5
A client with a traumatic brain injury from a motor vehicle crash is being monitored in the intensive care unit. The client's intracranial pressure (ICP) is $22 \mathrm{mmHg}$. Which nursing intervention is appropriate based on this finding?
Correct Answer: C
Rationale: ICP of 22 mmHg (elevated >20) requires mannitol (C) to reduce cerebral edema osmotically. Saline bolus (A) may worsen ICP. Flat bed (B) increases pressure. Coughing (D) raises ICP. C is correct. Rationale: Mannitol lowers ICP swiftly, a standard intervention in brain injury, per neurocritical care, preventing herniation unlike contraindicated actions.
Question 3 of 5
When a nurse is tried under criminal law, the nurse is being brought to trial by:
Correct Answer: A
Rationale: When a nurse faces a trial under criminal law, it involves a legal action initiated by the state or government, representing society as a whole, rather than a private entity or individual. Criminal law addresses offenses deemed harmful to the public, such as negligence causing harm or intentional misconduct. Unlike civil cases, where an individual or organization might sue for damages, criminal cases are prosecuted by the state to uphold public safety and justice. The nurse's actions are evaluated against legal standards that protect society, making this the most accurate description. Other options, like the plaintiff's lawyer or an individual, pertain more to civil litigation, while an organization might be involved in internal discipline but not a criminal trial. This distinction is critical in understanding the scope and authority behind criminal proceedings in nursing practice.
Question 4 of 5
When does the nurse chart an intervention that involves administering medication to a client?
Correct Answer: D
Rationale: Charting a medication intervention immediately after administration ensures accuracy and legal protection. Delaying until the shift ends, before the next dose, or within an hour risks forgetting details like dosage or client response compromising the record's reliability. Immediate documentation captures the exact time and outcome, such as pain relief post-analgesic, critical if issues arise later. This practice upholds standards, supports continuity of care, and defends the nurse in potential disputes, reflecting the urgency of real-time recording in dynamic clinical settings.
Question 5 of 5
Your assigned client has a leg ulcer that has a dressing on it. During your assessment, you find that the dressing is wet. The client admits to spilling water on the dressing. What action would be best on your part?
Correct Answer: B
Rationale: A wet dressing from water spill requires removal and replacement to prevent infection and maintain a healing environment. Reinforcing keeps moisture, drying with a hairdryer risks burns or contamination, and air drying is slow and ineffective. This action ensures wound integrity, a core nursing responsibility.