ATI LPN
ATI LPN Med Surg Exam 4 Questions
Extract:
Question 1 of 5
A home health nurse is collecting data from a patient who has heart failure and notes the patient has had a weight gain of 1.8 kg (4 lb), as well as generalized edema, since the last visit 3 days ago. Which of the following actions should the nurse take next?
Correct Answer: B
Rationale: Notifying the RN case manager of the change in status is essential because a weight gain of this magnitude, along with generalized edema, may indicate worsening heart failure, requiring timely assessment and possible treatment adjustment.
Question 2 of 5
A nurse is collecting data from a client at a follow-up clinic visit for acute low back pain. A goal for this client is to use proper body mechanics at all times. Which of the following findings indicates that the client is meeting this goal?
Correct Answer: D
Rationale: Facing the direction of movement prevents twisting of the spine, reduces strain on the back, and promotes safe movement, indicating proper body mechanics.
Question 3 of 5
A nurse is reinforcing teaching with a client who is taking benztropine to treat Parkinson's disease. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?
Correct Answer: C
Rationale: Difficulty voiding is an anticholinergic adverse effect of benztropine, as it can cause urinary retention, which should be reported immediately.
Extract:
Nurses Notes
Day 1:
Oriented to person, place, and time. Speech is slow. Unilateral resting tremors noted in right arm. Gait is slow and rigid.
6 months later:
Oriented to person and place, disoriented to date and time. Speech is slow and slurred. Bilateral resting tremors noted in extremities and generalized muscle stiffness. Facial rigidity and drooling noted. Gait is slow and client shuffles their feet when ambulating.
Question 4 of 5
A nurse is caring for a client. For each client finding, click to specify if the finding is consistent with Parkinson's disease, stroke, and/or multiple sclerosis. Each finding can support more than one disease process.
| Options | Parkinson's disease | Stroke | Multiple sclerosis |
|---|---|---|---|
| Ambulation pattern: Parkinson's disease | |||
| Muscle movements: Parkinson's disease | |||
| Speech: Parkinson's disease, Stroke, Multiple sclerosis | |||
| Orientation status: Parkinson's disease, Stroke, Multiple sclerosis | |||
| Facial rigidity: Parkinson's disease |
Correct Answer: A,B,C,D,E
Rationale: 1. Ambulation Pattern: The slow and shuffling gait is characteristic of Parkinson's disease due to muscle rigidity and bradykinesia. 2. Muscle Movements: Unilateral resting tremors and generalized muscle stiffness are hallmark signs of Parkinson's disease. 3. Speech: Slow and slurred speech is common in Parkinson's disease, stroke (due to dysarthria), and multiple sclerosis (due to neurological involvement). 4. Orientation Status: Disorientation can occur in later stages of Parkinson's disease, stroke, and multiple sclerosis due to cognitive decline. 5. Facial Rigidity: Facial rigidity, or 'masked face,' is a classic symptom of Parkinson's disease.
Extract:
Question 5 of 5
A nurse is caring for a client who is unconscious following a stroke. Which of the following nursing interventions is of highest priority?
Correct Answer: C
Rationale: Suctioning saliva is the highest priority to maintain airway clearance and prevent aspiration in an unconscious patient.