LPN LPN
ATI PN Comprehensive Predictor 2023
1. The nurse is performing triage on a group of clients in the emergency department. Which of the following clients should the nurse see first?
- A. A 12-year-old oozing blood from a laceration on the left thumb due to a cut from a rusty metal can
- B. A 19-year-old with a fever of 103.8°F who is able to identify her sister but not the place and time
- C. A 49-year-old with a compound fracture of the right leg who is complaining of severe pain
- D. A 65-year-old with a flushed face, dry mucous membranes, and a blood sugar of 470 mg/dL
Correct answer: B
Rationale: The correct answer is B. A 19-year-old with a fever of 103.8°F who is confused and unable to orient to place and time likely has a severe infection or a serious medical condition affecting the central nervous system. This client needs immediate attention as altered mental status combined with a high fever can indicate a life-threatening situation. Choices A, C, and D present important conditions that require medical care, but they are not as urgent as the 19-year-old with a high fever and confusion. The 12-year-old with a laceration may require treatment for bleeding and a tetanus shot, the 49-year-old with a compound fracture needs urgent orthopedic intervention, and the 65-year-old with a high blood sugar is concerning for hyperglycemia but can wait momentarily compared to the client with a fever and altered mental status.
2. What are the nursing interventions for a patient with COPD?
- A. Administer oxygen and provide breathing exercises
- B. Suction airway secretions and encourage coughing
- C. Administer bronchodilators and monitor oxygen saturation
- D. Restrict fluids and encourage mobility
Correct answer: A
Rationale: The correct answer is A: Administer oxygen and provide breathing exercises. These interventions are essential in managing COPD as they help improve lung function and oxygenation. Choice B is incorrect as suctioning airway secretions and encouraging coughing are not typically indicated for COPD patients. Choice C is incorrect as while administering bronchodilators is common in COPD treatment, monitoring oxygen saturation alone is not a comprehensive intervention. Choice D is incorrect as restricting fluids is not a standard intervention for COPD, and encouraging mobility, although beneficial, is not as directly related to managing COPD symptoms as administering oxygen and providing breathing exercises.
3. Which intervention should be included for a client with heart failure?
- A. Encourage increased fluid intake
- B. Weigh the client daily to monitor fluid balance
- C. Restrict fluid intake during meals
- D. Limit daily activity to prevent fatigue
Correct answer: B
Rationale: Weighing the client daily to monitor fluid balance is crucial for clients with heart failure. This intervention helps assess for fluid retention or depletion, providing valuable information for managing the condition effectively. Encouraging increased fluid intake (Choice A) is contraindicated in heart failure as it can worsen fluid overload. Restricting fluid intake during meals (Choice C) may lead to dehydration, which is harmful for clients with heart failure. Limiting daily activity (Choice D) is not recommended as appropriate activity levels should be encouraged for overall well-being, under guidance to prevent excessive fatigue.
4. A client has a prescription for ranitidine 150 mg PO BID. Available is ranitidine syrup 15 mg/mL. How many mL should the nurse administer each day?
- A. 20 mL
- B. 15 mL
- C. 25 mL
- D. 10 mL
Correct answer: A
Rationale: To administer a total of 300 mg daily (150 mg PO BID), the nurse should give 20 mL of the syrup. This is calculated by dividing the total daily dose (300 mg) by the concentration of the syrup (15 mg/mL), which equals 20 mL. Choice B (15 mL), C (25 mL), and D (10 mL) are incorrect because they do not accurately calculate the required volume of syrup needed to deliver the prescribed dose.
5. What are the complications of diabetic ketoacidosis?
- A. Electrolyte imbalance and dehydration
- B. Hypoglycemia and increased urination
- C. Kidney failure and respiratory distress
- D. Liver failure and hypertension
Correct answer: A
Rationale: The correct answer is A: Electrolyte imbalance and dehydration. Diabetic ketoacidosis can lead to imbalances in electrolytes such as potassium, sodium, and chloride, as well as dehydration due to excess urination and vomiting. These complications should be managed promptly with appropriate fluids and insulin. Choices B, C, and D are incorrect. Hypoglycemia and increased urination are not typical complications of diabetic ketoacidosis; kidney failure and respiratory distress may occur in severe cases but are not the primary complications. Liver failure and hypertension are not directly associated with diabetic ketoacidosis.
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