ATI LPN
LPN Nursing Fundamentals
1. A client with a new diagnosis of COPD is being taught about dietary management. Which of the following statements should be included in the teaching?
- A. You should increase your intake of high-calorie foods.
- B. You should decrease your intake of high-protein foods.
- C. You should avoid foods that contain lactose.
- D. You should increase your intake of high-fiber foods.
Correct answer: A
Rationale: The correct statement to include in the teaching for a client with a new diagnosis of COPD is that they should increase their intake of high-calorie foods. This is important to help maintain energy levels and manage weight. COPD can lead to increased energy expenditure due to the increased work of breathing, making it crucial to consume adequate calories for energy. High-calorie foods can help prevent weight loss and support overall nutritional status in COPD patients. Choice B is incorrect because high-protein foods are important for maintaining muscle mass in COPD patients. Choice C is incorrect as there is no need to avoid foods that contain lactose unless the client is lactose intolerant. Choice D is incorrect as increasing high-fiber foods may exacerbate symptoms like bloating and gas in COPD patients.
2. A client has been prescribed enoxaparin. Which of the following instructions should the nurse include?
- A. You need to obtain routine blood tests to monitor the effects of this medication.
- B. You should administer the medication into your thigh.
- C. You should inject the medication once daily.
- D. You need to use a 1-inch needle to administer the medication.
Correct answer: C
Rationale: The correct instruction to include when educating a client prescribed enoxaparin is to inject the medication once daily. Enoxaparin is typically administered via subcutaneous injection once daily, usually in the abdomen, to prevent blood clots.
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. A client has major fecal incontinence and reports irritation in the perianal area. Which of the following actions should the nurse take first?
- A. Apply a fecal collection system
- B. Apply a barrier cream
- C. Cleanse and dry the area
- D. Check the client's perineum
Correct answer: D
Rationale: When a client with major fecal incontinence reports irritation in the perianal area, the nurse's initial action should be to assess the client's perineum to gather more information. By checking the perineum, the nurse can identify the extent and nature of the irritation, allowing for appropriate interventions to be initiated. This assessment is crucial in developing a comprehensive care plan and addressing the client's immediate needs effectively. Applying the nursing process priority-setting framework helps in planning care and prioritizing nursing actions, making assessment the initial step in this scenario. Applying a fecal collection system (choice A) would be premature without assessing the perineal area first. Similarly, applying a barrier cream (choice B) or cleansing and drying the area (choice C) should follow the assessment to ensure appropriate interventions are chosen based on the assessment findings.
5. A healthcare professional is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following instructions should the healthcare professional include?
- A. Avoid drinking grapefruit juice.
- B. Take aspirin for pain relief.
- C. Consume a consistent amount of green leafy vegetables.
- D. Use an electric razor when shaving.
Correct answer: C
Rationale: Consuming a consistent amount of green leafy vegetables is important for clients taking warfarin as these foods contain vitamin K, which can affect the medication's effectiveness. Maintaining a consistent intake helps stabilize the International Normalized Ratio (INR) levels, which is crucial for monitoring the blood's ability to clot properly while on warfarin therapy. Choices A, B, and D are incorrect. Avoiding grapefruit juice is generally recommended with certain medications due to its interaction with liver enzymes, which is not directly related to warfarin. Taking aspirin along with warfarin can increase the risk of bleeding. Using an electric razor when shaving is a safety precaution for those at risk of bleeding, but it is not directly related to the medication warfarin.
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