ATI LPN Critical Thinking Exam

Extract:

Question 1 of 5

Select the type of assessment which is performed continuously throughout nurse-patient contact:

A. focusedB. body systemsC. subjectiveD. complete

Correct Answer: A

Rationale: Focused assessments (
A) are ongoing, targeting specific issues like pain or breathing during contact. Body systems (
B), subjective (
C), and complete (
D) assessments are not continuous.

Extract:

Patient appears to be in severe pain and refuses to ambulate. Blood pressure and pulse are elevated

Question 2 of 5

The nurse documents in the patient record, '0830 patient appears to be in severe pain and refuses to ambulate. Blood pressure and pulse are elevated. Physician notified and analgesic administered as ordered with adequate relief. J. Doe, RN.' The most significant statement about the documentation is that it is:

A. unacceptable because it is vague subjective data without supportive dataB. good because it shows immediate response to the problemC. inadequate because the time of physician notification is not listedD. acceptable because it includes assessment, intervention and evaluation

Correct Answer: D

Rationale: The documentation (
D) includes assessment (pain, vital signs), intervention (analgesic), and evaluation (relief), making it complete. A, B, and C overlook its comprehensive nature.

Extract:

Question 3 of 5

What is the major concern when using a computer for documentation?

A. confidentialityB. adequate forms for documentationC. incorrect informationD. of the answers are correct

Correct Answer: A

Rationale: Confidentiality (
A) is the primary concern due to risks of unauthorized access or breaches. B and C are managed by system design, and D is incorrect.

Question 4 of 5

On what form/forms should the nurse chart when administering a narcotic?

A. Physician's Order SheetB. Narcotic Administration SheetC. Care PlanD. MAR and Narcotic Administration Sheet

Correct Answer: D

Rationale: Narcotics are documented on both the MAR (Medication Administration Record) (
D) for all medications and the Narcotic Administration Sheet for controlled substances to ensure tracking and compliance. A, B alone, and C are incorrect.

Extract:

Patient was administered a stat insulin dose

Question 5 of 5

The nurse administered the stat insulin dose as ordered, in the presence of the nurse's aide and the dietary aide, however, the nurse failed to chart the medication on the MAR. During a legal deposition regarding charges of professional malpractice, it was determined that:

A. the insulin was administered based per the nurse's testimonyB. none of the answers are correctC. the insulin was administered based on the witness testimonyD. the insulin was not administered because it was not charted

Correct Answer: D

Rationale: Legally, 'if it wasn't documented, it wasn't done' (
D). Without MAR documentation, the insulin administration cannot be verified, despite testimony (A,
C). B is incorrect as D is accurate.

ATI LPN Critical Thinking Exam | Nurselytic

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