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ATI PN Comprehensive Predictor
1. A nurse is caring for a client who is postoperative following hip replacement surgery. Which of the following actions should the nurse take to prevent dislocation of the prosthesis?
- A. Cross the client's legs at the knees
- B. Maintain the client's legs in a neutral position
- C. Avoid placing a pillow under the client's knees
- D. Elevate the client's legs
Correct answer: C
Rationale: The correct action to prevent dislocation of the prosthesis after hip replacement surgery is to avoid placing a pillow under the client's knees. Placing a pillow can cause hip adduction, leading to dislocation. Crossing the client's legs at the knees and elevating the client's legs can also increase the risk of hip dislocation. Maintaining the client's legs in a neutral position is important to prevent complications.
2. A healthcare provider is providing discharge teaching to a client who is recovering from acute pancreatitis. Which of the following instructions should the healthcare provider include?
- A. Consume a low-fat diet.
- B. Limit your carbohydrate intake.
- C. Increase your protein intake.
- D. Take acetaminophen for pain management.
Correct answer: A
Rationale: Clients recovering from acute pancreatitis should consume a low-fat diet to reduce the workload on the pancreas and prevent exacerbation. This diet helps in minimizing the stimulation of pancreatic enzyme secretion, which aids in the recovery process. Choices B, C, and D are incorrect as limiting carbohydrate intake or increasing protein intake may not be necessary for acute pancreatitis, and acetaminophen may not be the first-line choice for pain management in this condition.
3. What are the early signs and symptoms of sepsis?
- A. Increased heart rate and fever
- B. Low blood pressure and confusion
- C. Rapid breathing and sweating
- D. Abdominal pain and cyanosis
Correct answer: A
Rationale: The correct answer is A: Increased heart rate and fever. In sepsis, an increased heart rate and fever are common early signs of systemic infection. While choices B, C, and D can be present in later stages of sepsis, they are not typically the initial signs. Low blood pressure and confusion may occur in severe sepsis or septic shock. Rapid breathing and sweating can be seen as sepsis progresses. Abdominal pain and cyanosis may develop as the condition advances but are not usually the earliest signs.
4. A client with moderate anxiety disorder is being taught stress management techniques by a nurse. Which response by the client indicates an understanding of the teaching?
- A. I will take a walk to reduce my anxiety
- B. I will imagine myself in a calm place when I can't concentrate
- C. I will meditate every other week
- D. I will cut back on my caffeine intake
Correct answer: B
Rationale: The correct answer is B because imagining oneself in a calm place is a relaxation technique that helps reduce anxiety. Walking, meditating every other week, or cutting back on caffeine intake may have their benefits, but they are not as directly related to the immediate management of anxiety as the visualization technique described in option B.
5. How should a healthcare provider assess a patient with sepsis?
- A. Monitor vital signs and administer fluids
- B. Monitor for fever and administer antibiotics
- C. Check for tachycardia and elevated white blood cell count
- D. Administer fluids and provide nutritional support
Correct answer: A
Rationale: In sepsis, it is crucial to monitor vital signs to assess the patient's condition and administer fluids to maintain circulation. This approach helps in stabilizing blood pressure and perfusion. While monitoring for fever and administering antibiotics (choice B) is important in managing sepsis, the initial priority lies in assessing and stabilizing the patient's hemodynamic status. Checking for tachycardia and elevated white blood cell count (choice C) can be part of the assessment but does not encompass the immediate intervention needed in sepsis. Administering fluids and providing nutritional support (choice D) are essential in managing sepsis, but the primary step should be to assess the patient's condition through vital sign monitoring.
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