LPN LPN
ATI PN Comprehensive Predictor 2023 with NGN
1. A nurse is caring for a client receiving IV fluids. Which of the following should the nurse do upon noticing phlebitis at the IV site?
- A. Apply a cold compress to the site
- B. Notify the provider immediately
- C. Remove the IV catheter and restart it in another location
- D. Monitor the site for signs of infection
Correct answer: C
Rationale: Upon noticing phlebitis at the IV site, the nurse should remove the IV catheter and restart it in another location. Phlebitis is inflammation of the vein, and leaving the IV catheter in place can lead to further complications such as infection. Applying a cold compress (Choice A) may provide temporary relief but does not address the underlying issue. Notifying the provider immediately (Choice B) is important, but the immediate action to prevent complications is to remove the IV catheter. Monitoring the site for signs of infection (Choice D) is necessary, but the priority action is to remove and reinsert the IV catheter to prevent worsening of the phlebitis.
2. What is the nurse's priority when caring for a client with a tracheostomy who is showing signs of respiratory distress?
- A. Administer a bronchodilator
- B. Suction the tracheostomy
- C. Notify the physician immediately
- D. Increase the oxygen flow rate
Correct answer: B
Rationale: The correct answer is to suction the tracheostomy. When a client with a tracheostomy is experiencing respiratory distress, the priority intervention is to clear the airway by suctioning the tracheostomy to remove secretions that may be obstructing the air passage. Administering a bronchodilator (Choice A) may be considered if bronchospasm is present, but the immediate focus should be on clearing the airway. Notifying the physician (Choice C) is important but should not delay the immediate intervention of suctioning. Increasing the oxygen flow rate (Choice D) may provide temporary relief, but addressing the root cause of the distress by suctioning is the priority.
3. What is the most appropriate strategy for a client with an NG tube who is experiencing nausea and decreased gastric secretions?
- A. Increase the suction pressure
- B. Irrigate the NG tube with sterile water
- C. Turn the client onto their side
- D. Replace the NG tube with a new one
Correct answer: B
Rationale: Irrigating the NG tube with sterile water is the most appropriate strategy for a client with an NG tube experiencing nausea and decreased gastric secretions. This intervention helps in relieving blockages within the tube and can help reduce nausea by ensuring proper drainage. Increasing the suction pressure (Choice A) can lead to complications and should not be done without healthcare provider orders. Turning the client onto their side (Choice C) is a general measure for patient comfort but does not directly address the issue with the NG tube. Replacing the NG tube with a new one (Choice D) is not necessary unless there are specific indications like tube damage or dislodgement.
4. A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following findings should indicate to the nurse that the medication has been effective?
- A. Cardiac workload decreases
- B. Blood pressure increases
- C. Respiratory rate increases
- D. Temperature decreases
Correct answer: A
Rationale: The correct answer is A: Cardiac workload decreases. Digoxin helps reduce cardiac workload in clients with heart failure, improving symptoms. This reduction in workload indicates that the medication is effective. Choice B, blood pressure increases, is incorrect because digoxin typically does not directly affect blood pressure. Choice C, respiratory rate increases, is incorrect as an increased respiratory rate is not a typical indicator of digoxin effectiveness. Choice D, temperature decreases, is also incorrect as digoxin does not typically affect body temperature.
5. How should a healthcare professional assess and manage a patient with acute renal failure?
- A. Monitor urine output and administer diuretics
- B. Administer IV fluids and restrict potassium intake
- C. Monitor electrolyte levels and provide dietary education
- D. Administer potassium and restrict fluids
Correct answer: A
Rationale: In acute renal failure, it is crucial to monitor urine output to assess kidney function and fluid balance. Administering diuretics helps manage fluid levels by promoting urine production. Choice B is incorrect because administering IV fluids can worsen fluid overload in renal failure patients, and restricting potassium intake is not typically the initial approach. Choice C is not the primary intervention but is important for long-term management. Choice D is incorrect as administering potassium can be dangerous in renal failure, and restricting fluids can lead to dehydration.
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