ATI LPN adult medical surgical 2023 | Nurselytic

Questions 61

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ATI LPN Test Bank

ATI LPN adult medical surgical 2023 Questions

Extract:


Question 1 of 5

A nurse is contributing to the plan of care for a client who has Alzheimer's disease. Which of the following interventions should the nurse include in the plan?

Correct Answer: B

Rationale: Limiting instructions to two steps accommodates cognitive decline in Alzheimer's, enhancing comprehension and reducing frustration.

Extract:

Nurses' Notes
Vital Signs
Diagnostic Results
Day 1:

Client brought to the emergency department (ED) following a fall that occurred while downhill skiing. Client states they fell when turning to avoid hitting another skier. Client reports feeling a severe, sudden pain of the right leg upon falling. Right leg was immobilized at the scene and the client transported to the ED.

Client states they were wearing a helmet while skiing. Client reports no headache or loss of consciousness.

Client reports pain as 10 on a scale of 0 to 10 to the right lower leg just below the knee and is unable to bear weight.

Right proximal tibia ecchymotic and swollen below the knee. Area is painful to touch. Open area noted on skin with bone visible. Right knee appears displaced. Left pedal pulses 3+, foot warm with intact movement and sensation. Right pedal pulses.


Question 2 of 5

A nurse is assisting in the care of the client who is postoperative following a fasciotomy. Which of the following actions should the nurse take?

Correct Answer: A,C,D

Rationale: Wound culture assesses for infection, analgesics manage pain, and antibiotics treat potential infection post-fasciotomy; fluid restriction and oxygen are not indicated.

Extract:


Question 3 of 5

A nurse is reinforcing teaching with a client who is premenopausal. Which of the following statements by the nurse is appropriate regarding breast self-examinations?

Correct Answer: C

Rationale: Using small, circular motions in a vertical pattern is the correct technique for breast self-examination, making this an appropriate statement.

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 4 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?

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.

Extract:


Question 5 of 5

A nurse is assisting in the care of a client following a tonsillectomy who is alert and has an SpO2 of 93% on room air. Which of the following actions should the nurse take?

Correct Answer: C

Rationale: Placing the client in a semi-Fowler's position promotes airway clearance and comfort post-tonsillectomy, especially with an SpO2 of 93%.

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