ATI LPN
LPN Fundamentals of Nursing
1. A client with meningitis is being assessed by a healthcare provider. Which of the following findings should the provider expect?
- A. Negative Brudzinski’s sign.
- B. Flaccid neck muscles.
- C. Petechial rash.
- D. Hypoactive deep tendon reflexes.
Correct answer: C
Rationale: A petechial rash is a characteristic finding in clients with meningitis, indicating small, pinpoint hemorrhages under the skin. This rash results from the infection's impact on the blood vessels. Petechiae are important to recognize as they can help differentiate meningitis from other conditions with similar symptoms. Brudzinski’s sign, neck stiffness, and positive Kernig’s sign are more common physical exam findings in meningitis. Flaccid neck muscles and hypoactive deep tendon reflexes are not typically associated with meningitis.
2. A client has a new prescription for a low-fat diet. Which of the following foods should be recommended?
- A. Bacon
- B. Whole milk
- C. Chicken breast
- D. Cheese
Correct answer: C
Rationale: When following a low-fat diet, it is essential to choose foods that are low in fat. Chicken breast is a lean protein source that is low in fat, making it a suitable option for a low-fat diet. Bacon, whole milk, and cheese are higher in fat content and should be avoided or limited in a low-fat diet. Bacon is high in saturated fat, whole milk contains significant amounts of fat, including saturated fat, and cheese is also high in fat. Therefore, these options are not ideal for a low-fat diet.
3. A client has a new prescription for a potassium-sparing diuretic. Which of the following foods should the nurse recommend?
- A. Bananas
- B. Oranges
- C. Spinach
- D. Apples
Correct answer: D
Rationale: Clients on potassium-sparing diuretics need to avoid high-potassium foods to prevent hyperkalemia. Apples are a low-potassium fruit, making them a suitable recommendation for clients on this type of diuretic. Bananas, oranges, and spinach are high-potassium foods that should be avoided by clients taking potassium-sparing diuretics to prevent complications such as hyperkalemia.
4. When teaching a client with a new diagnosis of hepatitis about dietary management, which of the following statements should the nurse include?
- A. Increase your intake of high-protein foods.
- B. Decrease your intake of high-protein foods.
- C. Avoid foods that contain lactose.
- D. Increase your intake of dairy products.
Correct answer: B
Rationale: For a client with hepatitis, it is important to decrease the intake of high-protein foods. High-protein foods can be harder for the liver to process and may exacerbate symptoms or contribute to liver damage. Recommending a diet with moderate protein intake is beneficial for managing symptoms and promoting liver health. Choice A is incorrect as increasing high-protein foods can strain the liver. Choice C is not directly related to hepatitis unless there is an intolerance present. Choice D is also incorrect because increasing dairy products may not be suitable for all individuals with hepatitis, especially if there are underlying liver conditions that could be aggravated by certain dairy components.
5. A client has a new prescription for total parenteral nutrition (TPN). Which of the following actions should the nurse plan to take?
- A. Obtain a random blood glucose daily.
- B. Change the IV tubing every 72 hours.
- C. Apply a new dressing to the IV site every 24 hours.
- D. Weigh the client weekly.
Correct answer: A
Rationale: When a client is on total parenteral nutrition (TPN), monitoring blood glucose levels daily is crucial to manage and detect complications like hyperglycemia, which can occur due to the high glucose content in TPN solutions. Regular blood glucose monitoring helps the healthcare team adjust the TPN infusion rate to maintain optimal glucose levels and prevent adverse events. Choices B, C, and D are incorrect because changing IV tubing every 72 hours, applying a new dressing to the IV site every 24 hours, and weighing the client weekly are not specific actions directly related to monitoring and managing the effects of TPN, particularly in relation to glucose levels.
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