ATI LPN
LPN Fundamentals of Nursing
1. A healthcare provider is assessing a client who has anemia. Which of the following findings should the healthcare provider expect?
- A. Bradycardia.
- B. Pallor.
- C. Hypertension.
- D. Jaundice.
Correct answer: B
Rationale: Pallor is a common finding in clients with anemia due to decreased hemoglobin levels. Anemia leads to reduced oxygen-carrying capacity in the blood, resulting in pale skin and mucous membranes, which is known as pallor. Bradycardia, hypertension, and jaundice are typically not associated with anemia.
2. A healthcare provider is planning care for a client who has a new prescription for a high-fiber diet. Which of the following foods should the healthcare provider recommend?
- A. White bread
- B. Canned fruit
- C. Cheese
- D. Brown rice
Correct answer: D
Rationale: Brown rice is a whole grain that is high in fiber, making it an excellent choice for a high-fiber diet. Foods like white bread, canned fruit, and cheese are typically low in fiber and would not be the best recommendation for a high-fiber diet. White bread is processed and lacks the fiber content found in whole grains like brown rice. Canned fruit, although containing some fiber, often has added sugars and lower fiber content compared to fresh fruits. Cheese is a dairy product that is generally low in fiber and not a significant source of dietary fiber compared to whole grains.
3. A healthcare professional is assessing a client who has deep-vein thrombosis (DVT). Which of the following findings should the professional expect?
- A. Swelling of the affected limb.
- B. Diminished peripheral pulses.
- C. Coolness of the affected limb.
- D. Redness and warmth of the affected limb.
Correct answer: D
Rationale: Redness and warmth of the affected limb are classic signs of deep-vein thrombosis (DVT) due to inflammation and increased blood flow. These symptoms occur as a result of the blood clot obstructing normal blood flow and causing localized inflammation in the affected limb. Swelling of the affected limb, diminished peripheral pulses, and coolness are not typically associated with DVT. Swelling can be present but is often accompanied by the characteristic redness and warmth. Diminished pulses and coolness are more indicative of arterial insufficiency rather than venous thrombosis.
4. A client is receiving continuous enteral feedings. Which of the following interventions should the nurse implement?
- A. Monitor intake and output every 8 hours.
- B. Flush the feeding tube every 4 hours.
- C. Measure the client's temperature every 24 hours.
- D. Change the feeding bag and tubing every 72 hours.
Correct answer: B
Rationale: The correct answer is B: Flush the feeding tube every 4 hours. Flushing the feeding tube every 4 hours is essential to maintain patency and prevent clogging, ensuring the client receives the prescribed enteral nutrition without interruption. This intervention helps prevent complications such as tube occlusion. Monitoring intake and output is important for assessing the client's hydration status but does not directly address tube patency. Measuring the client's temperature is essential for monitoring for signs of infection but is not directly related to tube maintenance. Changing the feeding bag and tubing every 72 hours is important for infection control but does not address tube patency.
5. A client has a pressure ulcer. Which of the following findings indicates healing of the ulcer?
- A. Increase in drainage.
- B. Decrease in size.
- C. Presence of foul odor.
- D. Reddened wound edges.
Correct answer: B
Rationale: When a pressure ulcer is healing, there is a decrease in its size as the tissue repair progresses. This reduction in size is a positive indication of the healing process. An increase in drainage, presence of foul odor, or reddened wound edges are typically signs of infection or lack of improvement. Therefore, the correct answer is a decrease in size.
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