ATI LPN
LPN Fundamentals of Nursing
1. A healthcare professional is assessing a client who has fluid volume overload. Which of the following findings should the healthcare professional expect?
- A. Hypotension.
- B. Bradycardia.
- C. Crackles in the lungs.
- D. Flat neck veins.
Correct answer: C
Rationale: Crackles in the lungs are a classic sign of fluid volume overload. When there is an excess of fluid in the lungs, it can manifest as crackling sounds upon auscultation. This finding indicates the accumulation of fluid in the alveoli and interstitial spaces of the lungs, which is a common manifestation of fluid volume overload.
2. 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.
3. A healthcare professional is preparing to administer a subcutaneous injection of insulin. Which of the following actions should the professional take?
- A. Use a 1-inch needle.
- B. Insert the needle at a 90-degree angle.
- C. Use a tuberculin syringe.
- D. Aspirate before injecting.
Correct answer: B
Rationale: When administering a subcutaneous injection, inserting the needle at a 90-degree angle is appropriate. This angle helps ensure proper delivery of the medication into the subcutaneous tissue. Using a 1-inch needle is common for subcutaneous injections to reach the subcutaneous fat layer adequately. Tuberculin syringes are typically used for intradermal injections, not subcutaneous injections. Aspirating before injecting is not necessary for subcutaneous injections as it is primarily used for intramuscular injections to ensure the needle is not in a blood vessel.
4. A client is being discharged with a prescription for furosemide. Which of the following instructions should be included?
- A. Avoid foods high in potassium.
- B. Monitor your weight daily.
- C. Take the medication with food.
- D. Change positions slowly.
Correct answer: D
Rationale: The correct instruction to include for a client being discharged with a prescription for furosemide is to 'Change positions slowly.' Furosemide, a diuretic, can cause dizziness and orthostatic hypotension, increasing the risk of falls. By advising the client to change positions slowly, the body can adjust to postural changes gradually, reducing the likelihood of falls and related injuries.
5. A client with a new diagnosis of diabetes mellitus is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will take my insulin only if my blood sugar is above 200 mg/dL.
- B. I will eat a snack before exercising.
- C. I will avoid all carbohydrates.
- D. I will check my blood sugar once a week.
Correct answer: B
Rationale: Eating a snack before exercising is crucial for managing blood sugar levels and preventing hypoglycemia in individuals with diabetes. Exercising on an empty stomach can lead to low blood sugar levels, but consuming a snack before physical activity helps stabilize blood sugar and provides energy for the body. This proactive approach demonstrates the client's understanding of the importance of managing blood sugar levels during physical activity.
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