ATI LPN
LPN ATI Fundamental Exam Questions
Extract:
Question 1 of 5
A nurse is preparing to administer enteral feeding to a client who has an NG tube in place. Which of the following methods should the nurse use to verify the correct placement of the NG tube?
Correct Answer: A
Rationale: Correct. Checking the pH of the gastric aspirate is the most reliable method to verify the correct placement of the NG tube. Gastric aspirate typically has an acidic pH (pH < 5), indicating that the tube is in the stomach. Observing the color of the gastric aspirate after adding blue dye to the formula is not a standard or recommended method for verifying NG tube placement. Auscultating over the epigastrium may help to identify the presence of air in the stomach, but it does not confirm that the NG tube is correctly placed in the stomach or the intestines. Measuring the length of the inserted NG tube can help determine the distance from the nose to the stomach, but it does not ensure correct placement in the stomach.
Question 2 of 5
A nurse is preparing to collect data from a client for a health assessment. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Provide privacy for the client: CORRECT. The nurse should promote a therapeutic environment by providing privacy while data is being collected for a health assessment. Expose hair of the body as an: INCORRECT.
To promote a therapeutic environment, the nurse should expose only the area of the body from which data is being collected.
Question 3 of 5
A nurse is caring for a postoperative client who is at risk for thrombus formation. Which of the following interventions should the nurse delegate to an assistive personnel (AP)?
Correct Answer: A
Rationale: Applying thromboembolic stockings (compression stockings) to the client's legs is a task that can be safely delegated to assistive personnel. The nurse should provide clear instructions on how to apply them properly. Incorrect. Monitoring the circulation in all four extremities requires clinical judgment and skilled assessment, and it should not be delegated to assistive personnel. Incorrect. Recording the condition of the client's skin requires observation and assessment, which should not be delegated to assistive personnel.
Question 4 of 5
A nurse is reinforcing preoperative teaching with a client about how to turn, cough, and deep breathe. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: B
Rationale: This can help prevent nausea.' Turning, coughing, and deep breathing exercises are not primarily aimed at preventing nausea. These exercises are designed to maintain lung function and prevent respiratory complications. 'This can help prevent pneumonia.' Correct. Turning, coughing, and deep breathing exercises are essential postoperative activities that help prevent the development of pneumonia by promoting lung expansion, clearing mucus, and preventing atelectasis. 'I should do this every 4 hours.' The frequency of turning, coughing, and deep breathing exercises may vary based on individual client needs and surgical procedures. This statement does not demonstrate a specific understanding of the appropriate timing for these exercises. 'I should do this to keep my heart from beating too fast.' Turning, coughing, and deep breathing exercises are not directly related to heart rate regulation. They are focused on lung expansion and airway clearance.
Question 5 of 5
A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci. Which of the following interventions should the nurse recommend to be included in the plan of care?
Correct Answer: B
Rationale: Placing the client in a room with another client who has pharyngitis is not recommended. Pharyngitis can be caused by various different pathogens, not just streptococci. Co-housing clients with different infections can lead to cross-infection, complicating both clients' conditions.
Therefore, this choice is not the best option. Ensuring that the client wears a surgical mask during transportation throughout the facility is the correct choice. Streptococcal infections are spread through respiratory droplets. A surgical mask can help prevent the spread of these droplets, protecting other clients and healthcare workers in the facility. This is a standard precaution in infection control. Limiting the client's visitors to visitations of 30 minutes is not necessarily beneficial. The duration of the visit does not significantly impact the risk of transmission as much as the precautions taken during the visit, such as hand hygiene and wearing a mask.
Therefore, while limiting visitation time might reduce exposure, it is not the most effective measure to prevent the spread of infection. Providing the client a room with negative pressure airflow of six air exchanges per hour is not necessary for a client with a streptococcal infection. Negative pressure rooms are typically used for clients with airborne diseases, such as tuberculosis. A streptococcal infection is spread through droplets, not airborne transmission, so a negative pressure room would not provide any additional benefit.