ATI LPN
LPN ATI Fundamental Exam Questions
Extract:
Question 1 of 5
A nurse is reinforcing teaching about the use of crutches with a client who has a fractured right tibia and fibula. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: A
Rationale: I will be sure to keep the crutch tips dry.' While it is important to keep the crutch tips dry to maintain traction and stability, this statement does not specifically address the correct technique for going up stairs with crutches. 'I will hold a crutch in each hand when sitting down.' This statement does not address the correct technique for going up stairs with crutches. However, it is a correct statement regarding sitting down with crutches. 'I will place my weight on my underarms.' Placing weight on the underarms is an incorrect crutch-walking technique. It can lead to nerve compression and injury. Instead, the client should bear weight on their hands and palms when using crutches. 'I will lead with my right leg when going upstairs.' Correct. When going up stairs with crutches, the client should lead with their unaffected leg (in this case, the right leg) first. The crutches are then advanced, one at a time, to the same step. This sequence ensures better stability and safety during stair climbing with crutches.
Question 2 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 3 of 5
Nurses notes 1100: Client received from PACU; initial vital signs recorded. Client drowsy but responds to verbal stimuli. Client is oriented to person, place, and time. Client can move all extremities. Hypoactive bowel sounds. Abdominal dressing intact with drainage noted and marked. Indwelling catheter in place and draining yellow urine. 1200: Upon waking, client reports nausea and rates pain as a 6 on a scale of 0 to 10. Abdominal dressing intact, no further drainage noted. Urine output of 15 mL since 1100. Morphine 4 mg IV bolus and metoclopramide 10 mg IV bolus administered. 1230: Client reports relief from nausea, but not pain. Client rates pain as an 8 on a scale of 0 to 10. No additional urine output since 1200.
Correct Answer: C,D,F
Rationale: A: The neurological findings were already noted in the nurse's initial assessment, and the client's orientation and movement of extremities are within the expected range postoperatively.
Therefore, it does not require immediate reporting. B: While the initial assessment indicated drainage on the dressing, there has been no further drainage since that time. A small amount of drainage following abdominal surgery is an expected finding and does not need to be reported to the provider unless drainage continues or increases over time. C: Monitoring urinary output is essential, especially in a postoperative client, as it helps assess renal function and hydration status. Any significant changes in urinary output should be reported to the provider promptly. D: The client's reported pain level of 6 on a scale of 0 to 10 indicates moderate pain, and the provider should be informed to address the pain and consider adjustments to the pain management plan. E: Gastrointestinal assessment is incorrect. While nausea and hypoactive bowel sounds were initially noted, the client reports relief after the administration of metoclopramide. F: Vital signs is correct. The client's heart rate and respiratory rate have increased, and their blood pressure and oxygen saturation levels have decreased. These findings should be reported to the provider.
Question 4 of 5
A nurse is preparing to administer oxygen to a client who has heart failure and is having severe difficulty breathing. Which of the following oxygen delivery equipment should the nurse select to provide the highest concentration of oxygen to the client?
Correct Answer: D
Rationale: A nasal cannula provides a low to moderate concentration of oxygen and is not suitable for a client experiencing severe difficulty breathing. A simple face mask provides a higher concentration of oxygen than a nasal cannula but may not deliver a high enough concentration for a client experiencing severe respiratory distress. A Venturi mask can provide a precise and adjustable concentration of oxygen but may not deliver the highest concentration needed in this scenario. A nonrebreather mask can deliver the highest concentration of oxygen (up to 100%) and is the most appropriate choice for a client experiencing severe difficulty breathing.
Question 5 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.