ATI LPN
ATI PN Fundamentals 2020 NGN Exam 1 Questions
Extract:
Question 1 of 5
A nurse is preparing to document information about a client's lower legs, which are swollen with 6 mm edema. Which of the following information should the nurse document?
Correct Answer: C
Rationale: 3+ pitting edema signifies moderately severe pitting edema with a noticeable indentation that aligns with 6 mm edema, making it the correct documentation.
Question 2 of 5
A nurse is collecting data from a client following a lumbar puncture. The nurse should identify which of the following findings as a potential adverse effect of this procedure?
Correct Answer: C
Rationale: Headache is a potential adverse effect of a lumbar puncture. This is caused by the leakage of cerebrospinal fluid (CSF) through the puncture site, leading to a decrease in CSF pressure. This drop in pressure can cause a headache, particularly when the client sits or stands up.
Question 3 of 5
A nurse is planning care for a group of clients. The nurse should expect to witness an informed consent for a client who will undergo which of the following procedures?
Correct Answer: B
Rationale: A paracentesis is an invasive procedure requiring informed consent due to risks like infection or bleeding, unlike the other routine interventions.
Question 4 of 5
A nurse is caring for a client who is receiving intermittent enteral feedings. Which of the following is the first action the nurse should take?
Correct Answer: A
Rationale: Measuring gastric residual before each feeding assesses tolerance and prevents complications like aspiration, making it the priority action.
Question 5 of 5
A nurse is preparing to obtain a client's vital signs. Which of the following actions should the nurse take when washing their hands?
Correct Answer: D
Rationale: After washing and drying hands, turning off the faucet with a clean paper towel is recommended to avoid recontaminating the clean hands.
Touching the faucet directly with clean hands could potentially transfer pathogens back onto the hands.