ATI LPN
ATI LPN Adult Medical Surgical 2023 II Questions
Extract:
Question 1 of 5
A nurse is reinforcing discharge teaching for a client who had a cerebrovascular accident (CVA). Which of the following statements should the nurse include?
Correct Answer: A
Rationale: Grab bars enhance safety and independence post-CVA by aiding balance in the shower.
Question 2 of 5
A nurse working the night shift is caring for an older adult client who has dementia and is at risk for falls. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: A motion sensor mat alerts staff to movement, reducing fall risk without restricting the client, which is safer for dementia patients.
Question 3 of 5
A nurse is obtaining a sterile urine specimen from a client who has an indwelling urinary catheter. Identify the sequence the nurse should follow.
Correct Answer: E,B,D,C,A
Rationale: The correct sequence ensures sterility and accuracy: clamp to collect urine, clean the port, aspirate, transfer, and document.
Question 4 of 5
A nurse is assisting with the care of a client who is receiving penicillin via intermittent IV bolus. Which of the following should the nurse recognize as a clinical manifestation of anaphylaxis?
Correct Answer: D
Rationale: Pruritus (itching) is a common early sign of anaphylaxis, a severe allergic reaction to penicillin.
Extract:
Vital Signs
Diagnostic Results
Pain Rating
Nurse’s Notes
Allergy History
• Blood pressure: 142/84 mm Hg
• Temperature: 38.5°C (101.3°F)
• Respiratory rate: 24/min
• Heart rate: 99/min
• SpO₂: 96% on room air
Question 5 of 5
A nurse is caring for a 45-year-old male client in a medical-surgical unit who has a new prescription for cefazolin. Which of the following findings should the nurse identify as contraindications to administering cefazolin? (Select all that apply.)
Correct Answer: A,C
Rationale: Penicillin allergy risks cross-reactivity with cefazolin; furosemide with cefazolin can enhance nephrotoxicity.