ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN
1. A healthcare provider is preparing to administer an influenza vaccine to an adult client. Which of the following is a contraindication?
- A. Client has a low-grade fever
- B. Client is allergic to eggs
- C. Client had recent surgery
- D. Client is on corticosteroid therapy
Correct answer: B
Rationale: The correct answer is B: Client is allergic to eggs. The influenza vaccine is contraindicated in individuals with an allergy to eggs because some influenza vaccines are produced using egg-based processes. Choices A, C, and D are not contraindications for administering the influenza vaccine. A low-grade fever, recent surgery, and corticosteroid therapy are not contraindications for receiving the influenza vaccine.
2. A nurse is providing discharge instructions for a client after surgery. Which of the following should be included?
- A. Resume normal activities immediately
- B. Monitor for signs of infection
- C. Avoid all physical activity for 1 month
- D. Take pain medications only as needed
Correct answer: B
Rationale: The correct answer is B: 'Monitor for signs of infection.' After surgery, it is essential for clients to watch for signs of infection, such as increased redness, swelling, or drainage at the incision site. Choice A is incorrect because resuming normal activities immediately after surgery can be harmful. Choice C is incorrect as complete avoidance of physical activity for a month is typically not necessary and can lead to complications like blood clots. Choice D is incorrect as taking pain medications only as needed may not provide adequate pain management post-surgery.
3. A home health nurse is providing teaching to a family of a client who has seizure manifestations as a result of an inoperable brain tumor. What intervention should the nurse include in the teaching?
- A. Administer antiseizure medications promptly.
- B. Use oral airway devices during seizures.
- C. Pad the side rails of the bed.
- D. Apply restraints during the seizure to prevent injury.
Correct answer: C
Rationale: The correct intervention the nurse should include in the teaching is to pad the side rails of the bed. By padding the side rails, the nurse can help prevent injury if the patient experiences a seizure. Administering antiseizure medications promptly (Choice A) is typically the responsibility of a healthcare provider or according to a prescribed schedule. Using oral airway devices during seizures (Choice B) can pose risks and should be managed by healthcare professionals. Applying restraints during a seizure (Choice D) is not recommended as it can lead to further injury and complications.
4. A client with chronic kidney disease is about to start hemodialysis. Which of the following instructions should the nurse include?
- A. Increase protein intake between dialysis sessions
- B. Reduce potassium intake
- C. Avoid iron supplements
- D. Expect weight gain after each dialysis session
Correct answer: B
Rationale: The correct answer is to instruct the client to reduce potassium intake. Clients with chronic kidney disease should limit potassium intake to prevent hyperkalemia, as the kidneys may struggle to remove excess potassium. Increasing protein intake between dialysis sessions (Choice A) is not recommended as it can increase urea production, adding to the workload of the kidneys. Avoiding iron supplements (Choice C) is not necessary unless iron levels are high. Expecting weight gain after each dialysis session (Choice D) is incorrect as patients typically experience weight loss due to fluid removal during dialysis.
5. A nurse is sitting with the partner of a client who recently died. Which of the following actions should the nurse take to facilitate mourning?
- A. Encourage the partner to ask for help when needed
- B. Suggest the partner avoid discussing their feelings
- C. Recommend immediate return to daily activities
- D. Advise the partner to remain strong
Correct answer: A
Rationale: The correct action for the nurse to take to facilitate mourning is to encourage the partner to ask for help when needed. Grieving is a challenging process, and offering support and encouragement to seek help can be beneficial. Choice B is incorrect because avoiding discussing feelings can hinder the grieving process by suppressing emotions. Choice C is also incorrect as an immediate return to daily activities may not allow the partner to properly process their grief. Choice D is not the best approach as advising the partner to 'remain strong' may discourage the expression of emotions and seeking support, which are essential in the mourning process.
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