ATI LPN
PN Adult Medical Surgical 2023 Questions
Extract:
Question 1 of 5
A nurse is reinforcing teaching with a client who will be wearing a Holter monitor for the next 24 hr. Which of the following information should the nurse include?
Correct Answer: A
Rationale: Recording activities helps correlate symptoms with heart activity; electrodes stay on, and bathing is avoided.
Extract:
Vital Signs
Today, 0700:
Blood pressure 122/68 mm Hg
Heart rate 99/min
Respiratory rate 20/min
Temperature 36.4° C (97.6° F)
Laboratory Results
Today, 0700:
Potassium 3.2 mEq/L (3.5 to 5 mEq/L)
Hct 44% (42% to 52%)
BUN 19 mg/dL (10 to 20 mg/dL)
Question 2 of 5
Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide? (Client with potassium 3.2 mEq/L)
Correct Answer: A
Rationale: Hypokalemia (3.2 mEq/L) is a contraindication as furosemide can worsen it, risking arrhythmias.
Extract:
Question 3 of 5
A nurse is preparing to administer epoetin 50 units/kg via subcutaneous injection to a client who weighs 165 lb and has chronic kidney disease. How many units should the nurse administer?
Correct Answer: A
Rationale: 165 lb = 75 kg; 50 units/kg × 75 kg = 3750 units, correct for stimulating RBC production in CKD.
Question 4 of 5
A nurse is preparing a client for a colposcopy following an abnormal Papanicolaou (Pap) test. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: A colposcopy is a diagnostic procedure to examine the cervix, vagina, and vulva after an abnormal Pap test, typically involving a speculum and mild discomfort but no cervical dilation. Option A is incorrect because inserting a tampon post-procedure could introduce infection or interfere with healing, especially if biopsies were taken. Option B is wrong as colposcopy does not require cervical dilation; it's a visual inspection, unlike procedures like a D&C. Option C, Sims' position (lateral with knees bent), is not standard lithotomy position is used instead for pelvic access. Option D is correct because advising the client to avoid sexual intercourse until healing prevents irritation, infection, or disruption of any biopsy sites, aligning with post-procedure care guidelines. This instruction supports recovery and ensures accurate follow-up results, making it the most appropriate nursing action.
Question 5 of 5
A nurse is contributing to the plan of care for a client who is starting bowel training for the management of fecal incontinence. Which of the following interventions should the nurse recommend?
Correct Answer: B
Rationale: Bowel training aims to establish a regular pattern for defecation, particularly for clients with fecal incontinence, by leveraging the gastrocolic reflex, which increases intestinal motility after meals. Option A is incorrect because limiting physical activity does not promote bowel regularity and may worsen incontinence by reducing muscle tone. Option B is correct as assisting the client to the restroom 30 minutes after meals takes advantage of this reflex, encouraging predictable bowel movements and enhancing control over time. Option C is wrong since high-fiber foods aid bowel regularity by adding bulk to stool, which helps with continence, not hinders it. Option D is also incorrect adequate fluid intake (not restriction to 1500 mL/day) supports healthy stool consistency and prevents constipation, a key factor in incontinence management. Assisting post-meal aligns with physiological principles and patient-centered care, making it the best intervention for effective bowel training.