ATI LPN adult medical surgical 2023

Extract:

Question 1 of 5

A nurse is contributing to the plan of care for a client following a total hip arthroplasty. Which of the following interventions should the nurse recommend?

A. Turn the client every 4 hr for 48 hr while on bed rest. B. Have the client use an incentive spirometer every 4 hr. C. Instruct the client to bend from the hip when retrieving items from the floor. D. Maintain hip abduction when turning the client.

Correct Answer: D

Rationale: Maintaining hip abduction prevents dislocation of the new hip joint, a critical consideration post-hip arthroplasty.

Question 2 of 5

A nurse is caring for a client who is postoperative following a right radical mastectomy. Which of the following actions should the nurse take to prevent the development of lymphedema?

A. Keep both arms below the level of the client's heart. B. Obtain blood pressure readings using the client's right arm. C. Use the client's left arm to obtain blood samples. D. Limit range-of-motion exercises with the affected arm

Correct Answer: C

Rationale: Using the left arm for blood samples avoids trauma to the right arm, reducing the risk of lymphedema after a right mastectomy.

Question 3 of 5

A nurse is transporting a client who has pneumonia and is on droplet precautions to radiology. Which of the following safety measures should the nurse take while transporting the client?

A. The client should wear a mask during transport. B. The nurse should wear a mask during transport. C. The nurse should wear a gown during transport. D. The client should wear a gown during transport.

Correct Answer: A

Rationale: The client wearing a mask during transport prevents the spread of droplet pathogens, consistent with droplet precautions for pneumonia.

Question 4 of 5

A nurse is reinforcing teaching with a client who is to take a fecal occult blood test at home. Which of the following instructions should the nurse include in the teaching?

A. Apply five drops of developer to each smear. B. Use the same part of stool for each sample. C. Ensure the sample contains no urine. D. Wait 10 min before applying the developing solution.

Correct Answer: C

Rationale: Ensuring the sample is free of urine prevents contamination, which could lead to inaccurate fecal occult blood test results.

Extract:

Nurses' Notes
Vital Signs
Day 1, 1000:

The client reports mid abdominal pain. Client reports pain as 7 on a scale of 0 to 10. The client states, "I haven't had a bowel movement in 4 days. The client states, “I also have vomited, once or twice."

Physical Exam:

General: uncomfortable, grimacing

HEENT: dry mucous membranes

Cardiovascular: S1, S2, no murmur

Respiratory: bilateral breath sounds clear

Gastrointestinal: tenderness to palpation, high-pitched bowel sounds

Skin: no jaundice noted

Social history: drinks 1 to 2 glasses of wine daily. Client reports no tobacco use.

Question 5 of 5

The nurse is assisting with the care of a client. The nurse is collecting data on the client. Which of the following findings require follow-up?

A. Blood pressure B. BUN level C. Potassium level Abdominal findings D. WBC count E. Breath sounds

Correct Answer: A,B,C,D

Rationale: Blood pressure, BUN, potassium, and abdominal findings (pain, constipation, vomiting, high-pitched bowel sounds) require follow-up due to potential dehydration or obstruction; breath sounds are normal and do not need follow-up.

ATI LPN adult medical surgical 2023 | Nurselytic

Nurselytic

ATI LPN

ATI LPN