LPN LPN
ATI NCLEX PN Predictor Test
1. How should a healthcare professional assess and manage a patient with delirium?
- A. Assess for confusion and reorient the patient
- B. Provide a quiet environment and administer sedatives
- C. Provide oxygen therapy and monitor vital signs
- D. Provide pain relief and monitor for signs of recovery
Correct answer: A
Rationale: The correct way to assess and manage a patient with delirium is by assessing for confusion and reorienting the patient. Delirium is characterized by acute confusion and disturbance in attention, so reorienting the patient to time, place, and person can help improve their awareness and cognition. Providing a quiet environment is important to reduce stimuli that can exacerbate delirium, but administering sedatives may worsen the condition. Oxygen therapy and monitoring vital signs are essential aspects of general patient care but are not specific to managing delirium. Providing pain relief is important for overall patient comfort but may not directly address the core issue of delirium.
2. A client at 30 weeks of gestation reports constipation. Which of the following recommendations should the nurse make?
- A. Drink 1 liter of water per day.
- B. Take a laxative every morning.
- C. Increase your intake of refined grains.
- D. Walk for at least 30 minutes every day.
Correct answer: D
Rationale: The correct recommendation is to walk for at least 30 minutes every day. Walking stimulates intestinal motility, which can help relieve constipation during pregnancy. Option A is important for overall hydration but may not directly address constipation. Option B is not recommended without healthcare provider approval as some laxatives are contraindicated in pregnancy. Option C, increasing intake of refined grains, may exacerbate constipation due to lower fiber content.
3. A client with a serum albumin level of 3 g/dL has a pressure ulcer. What should the nurse do first?
- A. Monitor the client's fluid and electrolyte balance
- B. Consult a dietitian to improve the client's nutritional status
- C. Administer a protein supplement
- D. Administer an anti-inflammatory medication
Correct answer: B
Rationale: The correct first action for a client with a serum albumin level of 3 g/dL and a pressure ulcer is to consult a dietitian to improve the client's nutritional status. Adequate nutrition is essential for wound healing. Monitoring fluid and electrolyte balance is important but not the first priority in this situation. Administering a protein supplement can be considered after dietary evaluation. Administering an anti-inflammatory medication is not the primary intervention for addressing a pressure ulcer related to low albumin levels.
4. The nurse is making a home visit with a client diagnosed with Alzheimer's disease. The client recently started on lorazepam (Ativan) due to increased anxiety. The nurse is cautioning the family about the use of lorazepam (Ativan). The nurse should instruct the family to report which of the following significant side effects to the healthcare provider?
- A. Paradoxical excitement
- B. Headache
- C. Slowing of reflexes
- D. Fatigue
Correct answer: A
Rationale: The correct answer is A, paradoxical excitement. Lorazepam can cause an unexpected response of paradoxical excitement, which should be reported to the healthcare provider. This reaction is characterized by increased anxiety, restlessness, and agitation instead of the expected calming effect. Choices B, C, and D are incorrect because headache, slowing of reflexes, and fatigue are more common side effects of lorazepam and may not warrant immediate reporting unless severe or persistent.
5. A nurse is preparing to administer insulin to a client who has type 1 diabetes mellitus. After drawing up the medication, the nurse accidentally brushes the needle on the counter's surface. Which of the following actions should the nurse take?
- A. Prepare a new dose of insulin injection
- B. Administer the insulin as it is
- C. Wipe the needle with an alcohol swab
- D. Ask the provider for guidance
Correct answer: A
Rationale: The correct action for the nurse to take is to prepare a new dose of insulin injection. Accidentally brushing the needle on a contaminated surface can lead to infection risk. Administering the insulin as it is or just wiping the needle with an alcohol swab would not be sufficient to eliminate the risk of infection. Asking the provider for guidance is not necessary in this situation as the nurse can independently take the appropriate action to ensure patient safety.
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