ATI LPN
Quizlet LPN Fundamentals Questions
Question 1 of 5
When writing goals/outcomes for clients, the nurse should do which of the following?
Correct Answer: C
Rationale: Involving the client in setting goals ensures outcomes reflect their values and needs, enhancing motivation and adherence. For example, a client with diabetes might prioritize dietary control over exercise, tailoring care to their lifestyle. Combining diagnoses or limiting them risks oversimplification, while team-driven goals may ignore client preferences. Client collaboration fosters autonomy and relevance like aiming for stable glucose levels making this the most effective approach for meaningful, achievable outcomes in nursing care planning.
Question 2 of 5
When counting the apical pulse during the physical assessment, it is the most accepted practice for the nurse to count the apical pulse in which of the following ways?
Correct Answer: D
Rationale: Counting the apical pulse for one full minute is most accepted, ensuring accuracy, especially if irregular. Shorter counts or dual pulse checks risk error. Nurses rely on this for precise cardiac assessment.
Question 3 of 5
Your assigned client, who has been talking with the doctor about pain control, later asks you what the doctor meant by 'pain threshold.' Which of the following would be the best reply?
Correct Answer: D
Rationale: Pain threshold is the stimulation level causing pain, distinct from relief, tolerance, or averages. Nurses clarify this for client understanding.
Question 4 of 5
Which musculoskeletal complication can occur due to prolonged immobility?
Correct Answer: C
Rationale: Prolonged immobility leads to osteoporosis, where bones weaken and become brittle due to reduced weight-bearing activity and mineral loss a significant risk for fractures. Muscle strength and joint flexibility decline, not improve, with disuse, and contractures become more likely as muscles shorten. Nurses combat this with range-of-motion exercises or weight-bearing support, recognizing that bone density loss is a pressing musculoskeletal threat in long-term immobility, necessitating preventive strategies to maintain skeletal health and patient mobility.
Question 5 of 5
Which intervention should the nurse prioritize to promote effective airway clearance in a client with impaired oxygenation?
Correct Answer: C
Rationale: Encouraging deep breathing and coughing (C) is the priority to promote airway clearance in impaired oxygenation, as it mobilizes secretions, preventing obstruction and enhancing gas exchange. Incentive spirometry (A) expands lungs but doesn't directly clear airways. Bronchodilators (B) relieve bronchospasm, aiding airflow, not secretion removal. High Fowler's (D) improves lung expansion but doesn't address secretions. Deep breathing inflates alveoli, while coughing expels mucus, directly tackling the root of impaired oxygenation, per respiratory therapy principles, reducing risks like atelectasis or pneumonia.