ATI LPN
Critical Care Respiratory Questions Questions
Question 1 of 5
Which statement by a client on oxygen therapy indicates the need for further education?
Correct Answer: B
Rationale: Securing the oxygen tubing under furniture legs can create a potential safety hazard by causing the tubing to become twisted or pulled, disrupting the oxygen flow. It is important to educate the client about keeping the tubing free from obstructions and ensuring it is positioned safely.
Question 2 of 5
A client who has endometrial cancer is receiving sealed internal radiation therapy. Which actions should the nurse implement? Select one that doesn't apply.
Correct Answer: C
Rationale: 1. Wearing a lead apron when providing care is recommended to protect the caregiver from radiation exposure. Always keep the front of the apron facing the client and do not turn so that the back of the caregiver is facing the client. 5. Women who are pregnant (including caregivers) should not enter the room. In addition, if the caregiver is attempting to conceive, whether they are male or female, they should not perform direct client care. Children younger than 16 should not be allowed to visit either. A 'Caution: Radioactive Material' sign should be placed on the door to the client’s room.
Question 3 of 5
During an admission assessment a client responds with rhyming statements such as 'tip, rip, dip and hip'. The nurse recognizes this speech pattern is associated with which mental health disorder?
Correct Answer: D
Rationale: This speech pattern is associated with psychotic disorders and schizophrenia. The client is exhibiting a type of speech called Clang association which is the meaningless rhyming of words, often in a forceful manner.
Question 4 of 5
A client who sustained a head injury has an intracranial pressure (ICP) monitor reading of 12 mm Hg. Which action should the nurse take?
Correct Answer: A
Rationale: An ICP reading of $12 \mathrm{~mm} \mathrm{Hg}$ is within the normal range (10 to $15 \mathrm{~mm} \mathrm{Hg}$ ). The nurse would continue with ongoing neurological assessment including vital signs, pupillary function, cranial nerve function, Glasgow Coma Scale, and sensory and motor response.
Question 5 of 5
The nurse is documenting on a patient with an SRD. What information must the nurse include in this documentation?
Correct Answer: B
Rationale: Documentation for SRDs must include objective patient-centered information. The nurse's feelings (A) are subjective and inappropriate for documentation. The specific type of SRD and patient assessment (B) are essential to ensure continuity of care and monitor for complications. Confirmation of a PRN order (C) is necessary to validate the use of SRDs. Assessing every 8 hours (D) is insufficient; SRDs require more frequent checks (e.g. every 1-2 hours) to ensure safety making B and C correct.