ATI LPN
Medical Surgical ATI Proctored Exam
1. What nursing intervention can help alleviate pruritus in a client with cirrhosis?
- A. Administering antihistamines
- B. Providing a high-protein diet
- C. Applying emollients to the skin
- D. Encouraging frequent baths with hot water
Correct answer: C
Rationale: Applying emollients to the skin can help alleviate pruritus in clients with cirrhosis. Emollients help soothe and moisturize the skin, reducing the discomfort associated with itching.
2. A patient with chronic pain is prescribed gabapentin. What is the primary purpose of this medication?
- A. Relieve neuropathic pain
- B. Reduce inflammation
- C. Enhance opioid analgesia
- D. Suppress cough
Correct answer: A
Rationale: Gabapentin is primarily prescribed to relieve neuropathic pain. It works by stabilizing electrical activity in the nerves, making it effective in managing conditions such as diabetic neuropathy, postherpetic neuralgia, and other forms of chronic pain originating from nerve damage.
3. The client is receiving intravenous vancomycin. Which assessment finding should the nurse report immediately?
- A. Red man syndrome.
- B. Blood pressure of 130/80 mm Hg.
- C. Mild itching at the IV site.
- D. Nausea and vomiting.
Correct answer: A
Rationale: Red man syndrome is a severe and potentially life-threatening reaction to vancomycin characterized by flushing, rash, and hypotension. Immediate intervention is required to prevent further complications such as anaphylaxis. Therefore, the nurse should report this finding immediately to ensure prompt treatment and prevent serious adverse effects.
4. A client is admitted with diabetic ketoacidosis (DKA). Which assessment finding requires immediate intervention?
- A. Fruity breath odor.
- B. Blood glucose of 450 mg/dL.
- C. Deep, rapid respirations.
- D. Serum potassium of 5.2 mEq/L.
Correct answer: C
Rationale: The correct answer is C: Deep, rapid respirations (Kussmaul breathing). This is a sign of severe acidosis commonly seen in diabetic ketoacidosis (DKA) and requires immediate intervention. Kussmaul breathing helps to compensate for the metabolic acidosis by blowing off carbon dioxide. Prompt intervention is necessary to prevent further deterioration and potential respiratory failure. Fruity breath odor (Choice A) is a classic sign of DKA but does not require immediate intervention. While a blood glucose level of 450 mg/dL (Choice B) is high, it does not pose an immediate threat to the client's life. Serum potassium of 5.2 mEq/L (Choice D) is slightly elevated but not the most critical finding that requires immediate intervention in this scenario.
5. A client with a cold is taking the antitussive benzonatate (Tessalon). Which assessment data indicates to the nurse that the medication is effective?
- A. Reports reduced nasal discharge.
- B. Denies having coughing spells.
- C. Able to sleep through the night.
- D. Expectorating bronchial secretions.
Correct answer: B
Rationale: The correct answer is B. Denying having coughing spells indicates the effectiveness of benzonatate, an antitussive that suppresses coughing. The goal of antitussive medications like benzonatate is to reduce or eliminate coughing, so the absence of coughing spells signifies the drug's efficacy. The other options do not directly reflect the medication's intended effect and are not specific indicators of benzonatate's effectiveness.
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