ATI LPN
LPN ATI Fundamental Exam Questions
Extract:
Question 1 of 5
A nurse is moving a client up in bed with the assistance of a second nurse. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Standing facing the center of the bed at the client’s side allows the nurse to maintain proper body mechanics and use their body weight to assist in moving the client. Placing feet apart with the foot nearest the head of the client’s bed in front of the other foot also helps the nurse maintain stability and leverage while moving the client. Keeping knees and hips straight while bending at the waist toward the client is incorrect body mechanics and can put a strain on the nurse’s back. Encouraging the client to keep their legs straight and remain still is not appropriate. The client should be actively involved in the movement, assisting as much as possible, to ensure their safety and cooperation.
Question 2 of 5
A nurse is contributing to a plan of care for a client who has a new prescription for a wrist restraint. Which of the following actions should the nurse include in the plan?
Correct Answer: B
Rationale: Check that the restraint is tied to a fixed frame of the bed: Restraints should never be tied to the side rails or a fixed frame of the bed, as this can lead to serious injuries. Restraints should be secured to the bed frame using quick release ties to ensure safety. Pad bony prominences on the wrist: Correct. Padding bony prominences on the wrist is an important step in the use of restraints to prevent skin breakdown and pressure injuries. Remove the restraint every 4 hr to allow movement: While repositioning and releasing restraints periodically is essential for the client’s comfort and safety, it is not appropriate to remove wrist restraints entirely every 4 hours, as they were prescribed for a specific purpose. Tie the restraint with a knot that will tighten when pulled: Restraints should never be tied with a knot that can tighten when pulled, as this can cause harm to the client and restrict blood flow. Restraints should be secured using quick release ties to allow for easy removal in emergencies.
Question 3 of 5
A nurse is contributing to the plan of care for a client who has a prescription for elastic bandages to the lower extremities. Which of the following actions should the nurse recommend for the plan of care?
Correct Answer: B
Rationale: Check the capillary refill every 4 hrs: Incorrect. The nurse should check capillary refill distally every 4 hr for a client who has elastic bandages on their lower extremities. Compare the pedal pulses every 4 hrs: CORRECT. The nurse should compare the pedal pulses bilaterally every week to check for adequate circulation for a client who has elastic bandages on their lower extremities.
Question 4 of 5
A nurse is reinforcing preoperative teaching with a client who speaks a different language than the nurse. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: Ask a family member who speaks the client’s primary language to interpret: While involving family members may seem helpful, it is not the most effective way to ensure accurate and complete communication. There may be language barriers or misunderstandings. Plan a long teaching session initially to introduce the necessary material: Lengthy teaching sessions may overwhelm the client and reduce their ability to absorb and retain information, especially when there is a language barrier. Provide the least important information first: This approach is not recommended because it does not prioritize the client’s understanding of essential preoperative instructions. Provide handouts written in the client’s primary language: Correct. Providing written materials in the client’s primary language allows them to review the information at their own pace and increases the likelihood of understanding important preoperative instructions.
Question 5 of 5
A nurse is reviewing the medical records of a client who has heart failure. The nurse should identify which of the following laboratory results as an indication that the client has fluid volume excess.
Correct Answer: D
Rationale: A urine specific gravity of 1.015 is within the normal range (1.005-1.030). While fluid volume excess may lead to a lower specific gravity due to urine dilution, this value does not indicate fluid overload and is considered normal. A hematocrit level of 42% is within the normal range for adults (men: 38-50%, women: 35-45%). Hematocrit levels tend to decrease in fluid volume excess due to hemodilution, but this value does not suggest fluid overload. A urine pH of 6.5 is within the normal range (4.5-8.0). Urine pH reflects the acid-base balance rather than fluid status and is not a reliable indicator of fluid volume excess. A BUN level of 5 mg/dL is below the normal range (10-20 mg/dL). In fluid volume excess, the dilution of blood plasma can lead to decreased BUN levels. This low BUN value, in conjunction with clinical symptoms, supports the diagnosis of fluid volume excess.